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HomeMy WebLinkAbout124317 ADVANCED ROOFING TECHNOLOGIES - INSURANCE CERTIFICATE (8)ADVAN-3 OP ID: DA ACORO CERTIFICATE OF LIABILITY INSURANCE DATE 0301 /20/01120Y7 17 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 CONTANAME: Diana Vigil Brown & Brown Inc 4532 Boardwalk Dr, Suite 200 sA/C No Ext :970-482-7747 FAXNo): 970-484-4165 Fort Collins, CO 80525 ADDRESS: dvigil@bbcolorado.com Karen E. Siwek, CPA INSURERS AFFORDING COVERAGE NAIC # INSURER A: Midwest Family Mutual Ins Co 23574 INSURED Advanced Roofing Technologies INSURER B: Pinnacol Assurance Company 41190 FOCO Sheet Metal INSURER C: Hamilton Specialty Insurance 13551 Brad Evans 4555 Highland Meadows Parkway INSURERD: Windsor, CO 80550 INSURERE: INSURER F : CnVFRA[.FS CFRTIFICATF NI IMRFR• R5=VICIn1V 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. ILTR TYPE OF INSURANCE DL UB POLICY NUMBER MM/DDPOLICY/YYYY MM DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE OCCUR CPCO05024430 03/01/2017 03/01/2018 DAMAGE TO RENTED PREMISES Ea occurrence $ 300,00 MED EXP (Any one person) $ 15,00 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY PRO ❑ LOC JECT PRODUCTS - COMP/OP AGG $ 2,000,00 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) A ANY AUTO CPCO05024430 03/01/2017 03/01/2018 _ $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ X NON -OWNED HIRED AUTOS AUTOS X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,00 AGGREGATE $ 2,000,00 A EXCESS LIAB CLAIMS -MADE CPCO05024430 03/01/2017 03/01/2018 DED I X I RETENTION $ 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A 4098470 03/01/2016 03/01/2017 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 11000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,00 A Leased/Rentd Eq CPCO05024430 03/01/2017 03/01/2018 Lsd/Rntd 150,000 C Pollution 6001311AA 03/01/2017 03/01/2018 Pollution $1M/2M DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins is included as additional insured per policy forms and conditions. See page 2. Waiver of Subrogation Applies l.tK I It -ILA I t NULUtK L;ANUtLLA I IUN CITYFOR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 580 Fort Collins, CO 80522-0580 AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD ADVAN-3 PAGE 2 NOTEPAD INSURED-SNAME Advanced Roofing Technologies OP ID: DA Date 03/01/2017 When Required By Written contract the following applies: 1 Liablity: lanket Additional Insured - MFMAC009 01-15 rimary 6 Non-contributory - MFMAC009 01-15 lanket Waiver of Subrogation - MFMAC010 01-15 er Project Aggregate - BP0702 07 02 utomobile: lanket Additinal Insured - MFM ML4 04 05 aiver of Subrogation- MFM ML5 04-05 Compensation: lanket Waiver of Subrogation- WC 00 03 13 ella: owing Form