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HomeMy WebLinkAbout596035 MASABI INC - INSURANCE CERTIFICATEA R CERTIFICATE OF LIABILITY INSURANCE �i19(/2018Y THIS CERTIFICATEIS 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 MESIROW INS SERVICES INC/BBT/PHS T551324 P: (-18-166) 467-8730 F: (888) 443-6112 PO BOX 29611 CHARLOTTE NC 28229 CONI"ACT NAM (A/CC,, No. Ex* (866) 467-8730 %� .No): (888) 443-6112 EMAIL SS: INSURER(S) AFFORDING COVERAGE NAICN INSURER A: Sentinel Ins Co, LTD INSURED MASABI, LLC 1330 AVE OF THE AMERICAS STE23A NEW YORK NY 10019 INSURER B INSURER C INSURER D: INSURER E: INSURER 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. L'YSX TYPEOFWSUXANCE ADD SUS I'ULIC'YNUMBEX YOL[47LIN M:,1211 YNY I'ULICYEYI' LLM1IIT.S COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1, 000, 000 CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $1 000,000 X X M ED EXP (Any one person) s10, 000 A General Liab 83 SBA TP9381 08/01/2018 08/01/2019 PERSONAL & ADV INJURY $ 1, 0 0 0, 000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PICOT ❑ LOG GENERAL AGGREGATE ; 2 , 000, 000 PRODUCTS - COMP/OP AGG ; 2, 0 0 0, 000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) S 1 000, 000 r BODILY INJURY (Per person) ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS 83 SBA TP9381 08/01/2018 08/01/2019 BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY S X UMBRELLA LUAB X OCCUR EACH OCCURRENCE s5,000,000 A EXCESS LIAB CLAIMS -MADE 83 SBA TP9361 08/01/2018 06/01/2019 AGGREGATE 5, 000, 000 DE X RETENTION S10 , 000 UIOAM"s GO1NP61V "I 21011 4NDEvftoYIE LL40ALM PER OTH- STATUTE ER ANY PROPRIETORIPARTNEWEXECUTIVEYIN E.L- EACH ACCIDENT OFFICERIMEMBEREXCLUDED? (Mandatory in Nit) ❑ wA E.L. DISEASE- EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT FIE] DESCRIPTION OF OPERATIONS /LOCATIONS! VEHICPKK)RD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. Please see Additional Remarks Schedule Acord Form 101 attached. It - City of Fort Collins 215 N Mason St PO 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. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC#_ ADDITIONAL REMARKS SCHEDULE Page of AGENCY MESIROW INS SERVICES INC/BBT/PHS NAMED INSURED MASABI , LLC 1330 AVE OF THE AMERICAS STE23A NEW YORK NY 10 019 POLICY NUMBER SEE ACORD 25 CARRIER SEE ACORD 25 NAIL CODE EFEECTIYEDATE: SEE ACORD 25 ACORD 101 (2014101) © 2014 ACORD CORPORATION. All rights reserved - The The ACORD name and logo are registered marks of ACORD