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Home My WebLink About102590 FRONT RANGE RAYNOR DOOR CO INC - INSURANCE CERTIFICATE (2)FRRAY-1 OP ID: JY ,�►coRo CERTIFICATE OF LIABILITY INSURANCE 5122/20 08 s/22/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: KAren CONTAE. Siwek, CPA Brown & Brown Inc PHONE 970-482-7747 F°X 4532 Boardwalk Dr, Suite 200 aC, No. Ell: (ac. No): 970�84-4165 Fort Collins, CO 80525 E-MAIL SS: certificates@bbcolorado.com Karen E. Siwek, CPA T INSURER A: Firemens Ins Comp of WA, DC 21784 INSURED Front Range Raynor Door Co Inc INSURERS:Pinnacol Assurance Company 41190 3847 S Mason Street Fort Collins, CO 80525 INSURERC: INSURER D : INSURER E: INSURER F : rr1VFRAr:FC rFRTIFIrATF NI IMRFR• RFVISIAN NI IMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES- LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1NSR LTR TYPE OF INSURANCE ADDL SUB POLICY NUMBER MM/ D/YYPOLICY YY MM/DDY� LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Al OCCUR CPA3030684-25 06/01/2018 06/01/2019 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED PREMISES Ea occurrence $ 300,00 MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 11000,00 GEN'L AGGREGATE LIMIT APPLIES PER: JPRO- POLICY � Fk] LOC OTHER. GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP/OP AGG $ 2,000,00 Emp Ben. $ 1,000,00 A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS CPA3030684-25 06/01/2018 06/01/2019 COMEaaccBINEDidentSINGLE LIMIT $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ $ PROPERTY DAMAGE Peraccident A UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE CPA3030684-25 06/01/2018 06/01/2019 EACH OCCURRENCE $ 2,000,00 AGGREGATE $ 2,000,00 DIED RETENTION $ $ B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICEER EXCLUDED? (Mandatory in NH) in If yes describe under DESCRIPTION OF OPERATIONS below N/A 4052719 4052718 06/01/2018 06/01/2018 06/01/2019 06/01/2019 X I PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 11000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE -POLICY LIMIT $ 1'000'00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is included as an Additional Insured per policy forms and conditions rFRTIFIrATF Hr11 IIFR rANr:FI I GTIr)N CITYFC3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins Purchasing Dept. P.O. BOX 580 Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE Karen E. Siwek, CPA U 1956-ZU14 AGUKU GUKPUKA I IUN. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD FRRAY-1 PAGE 2 NOTEPAD INSURED'S NAME Front Range Raynor Door Co Inc OP ID: JY Date 05/22/2018 required by written contract or agreement the following may apply: General Liability: Additional Insured - Ongoing - Form CG 2010 0413 Additional Insured - Completed Operations - CG 2037 0413 Blanket Additional Insured - Ongoing - Form CL CG 0059 0916 Blanket Additional Insured - Completed Operations - CL CG 2062 0916 Blanket Waiver of Subrogation - Form CL CG 0059 0916 Primary and Non -Contributory - Form CG 2001 0413 Per Project Aggregate - Form CL CG 0059 30 Day Notice of Cancellation - IL 0017 1198 tomobile: anket Additional Insured - Form CW 3468 0215 anket Waiver of Subrogation - Form CW 3468 0215 brella is Follow Form rkers Compensation: anket Waiver of Subrogation - Form 359-B