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Home My WebLink AboutBLACK TIMBER BUILDERS LLC - INSURANCE CERTIFICATE (6)ACO " CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 4/20/2018 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 have ADDITIONAL INSURED provisions or be endorsed. IfSUBROGATION 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 WINIALal NAME: Paula Blohm Madison Insurance Grou P FA PHONE 3033220800 3033220874 A/C No, Ext : (A/C, No): ADDRESS: pblohm@madisoninsurance.net 600 South Cherry St, Ste 900 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: PINNACOL ASSUR 41 190 Denver CO 80246 INSURED INSURER B : COLONY INSURANCE COMPANY INSURER C : Black Timber Builders, LLC INSURER D : 641 Whcdbee Street INSURER E : INSURER F : Fort Collins CO 80524 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDD/YYYY) LIMITS A X( COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR 103 GLOO14825-01 07/12/2017 07/12/2018 EACH OCCURRENCE $ 1,000,000 PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL a ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER. POLICY PE O LOC ROTHER GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (Per accident) $ UMBRELLA LIAB EXCESS LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ DED I I RETENTION $ $ A ORKERS COMPENSATION NND EMPLOYERS' LIABILITY Y I N NY PROPRIETOR/PARTNER/EXECUTIVE FFICERIMEMBER EXCLUDED? ❑ Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 4190143 03/01/2018 03/01/2019 XC I STATUTE ECRTH- E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Fort Collins P.O. Box 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE pa,IA4a, 4t4. ACORD 25 (2016103) The ACORD name and logo are registered ►I1dr1(.D988-2A4LLJ15ACORD CO RPORATjON. RD All rights r65 d