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MCDAVID CONSTRUCTION INC - INSURANCE CERTIFICATE (7)
MCDACON-01 EHINKLE ,44co/ear CERTIFICATE OF LIABILITY INSURANCE `—� DATE 12/16/2016Y) 12/16/2016 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 LeBaron & Carroll LLC 1350 E Southern Avenue Mesa, AZ 85204 CONTACT Emily Hinkle NAME: PHONE FAX (A/C, No, Ezt): (480) 464-3406 A/C, No :(480) 844-9866 Apo IE , Emily@LebaronCarroll.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Depositors 42587 INSURED INSURERB:AMCO Insurance Company 19100 INSURER C : Copperpoint General Ins Co 13043 McDavid Construction, Inc. INSURERD: Nationwide Mutual Insurance Co 23787 2239 E. Rose Garden Loop Phoenix, AZ 85204 INSURER E INSURER F : 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR DDfYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F—X] OCCUR ACP3016959762 12/18/2016 12/18/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMI E Ea occurre ce 100,000 $ MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECT LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY ACP3016959762 12/18/2016 12/18/2017 CMBINED SINGLE LIMIT EOa accident 1,000,000 $ X BODILY INJURY Perperson) $ BODILY INJURY Per accident $ X PROPERTY DAMAGE Per accident $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE ACP3016959762 12/18/2016 12/18/2017 EACH OCCURRENCE $ 2,000,000 F� AGGREGATE $ 2,000,000 DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 1017576 09/01/2016 09/01/2017 X PER OH - STATUTE ER E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE 1,000,000 E.L. DISEASE -POLICY LIMIT _$ 1,000,000 $ D Leased/Rented Equip ACP3016959762 12/18/2016 12/18/2017 Limit 60,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE 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 City of Fort Collins PO Box 580 ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD