HomeMy WebLinkAboutANTLER CONSTRUCTION CO - INSURANCE CERTIFICATE (9)DAT/DDIYYYY)
A
CERTIFICATE OF LIABILITY INSURANCE o6/27s/27/2o1s
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.
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 CONTACT
NAME:
Pinnacol Assurance PHONE FAX
7501 E. Lowry Blvd. WC. `��= IIn, No):
Denver, CO 80230-7006 ADDRESS' -------------- .------------- ------ —T---
_ INSURER(S) AFFORDING COVERAGE _ __ NAIC #
INSURER A: Pinnacol Assurance 41190
INSURED INSURER S :
Antler Construction Company
546 Se 8th St Unit B4 - INsuRERc:
Loveland, CO 80537 INSURER D :
INSURER E :
!`nvED A f_cl' f`C0TIFIr`AT1= NUIMRFR- RFVISION NUMRFR-
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.
MR _ - 61iS-lJ� - POLICY EFF POLICY EX P LlMt1$
LTR TYPE OF INSURANCE POLICY NUMBER MMIDDf/YYY MMrDDfYY
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE II�._ OCCUR
EACH OCCURRENCE
S
PREMISES Ea occurrence
E'
LIED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GEWL AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$
PRODUCTS -COMPIOPAGG
S _
POLICY 7,JJE T[71 LOC
OTHER'
AUTOMOBILE LIABILITY
COMBINED ING IT
Ea aaident
S
BODILY INJURY (Per person)
$
�ANY AUTO
_ I OWNED SCHEDULED
'AUTOS ONLY AUTOS
-� HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
BODILY INJURY (Per accident)
S
PROPERTY DAMAGE
era
S
S
UMBRELLA LIAB HOCOUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB CLAIMS -MADE
S
DEO I I RETENTION
—FoR
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ECUTIVE Y❑
A OFFICE PRIET EREXCLUER/E Y
OFFICE IMEMB R�PART EXCLUDED?
I (Mandatory in NH)
N / A
4149254
07/O1 /2018
07/Dl /2019
X STATUTE E
E.L. EACH ACCIDENT
$ 1 ,000,000
E.L. DISEASE - EA EMPLOYEE$
1,000,000
E.L. DISEASE -POLICY UMR
$ 1 000 000
I If yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Refer to the Acord 101 Additional Remarks Schedule for supplemental cancellation notification information.
Excluded (If any) : Nicole Corlett, Nathan Corlett
L.tK I11-19-A It MULUCK Vl11YVL1-LI'1 1-1.
1907973
Ft. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of
330 S. Ft. Collinsli Ave. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 580
Fort Collins, CO 80522
AUTHORIZED REPRESENTATIVE
Western Group, Inc/ Wheatridge
lJ 1y88-GVTO /iVVKU Vvrtl'vrcM rtvrv. nn uynw rcacr vcu.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
ACORDs provided by Forms Boss. www.FormsBoss.com; (c) Impressive Publishing 800-208-1977