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HomeMy WebLinkAboutPEAK ELEVATOR LLC - INSURANCE CERTIFICATE (2)PEAKELE-01 PARAN1 ACORO CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YYYY) 04/28/2017 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 CONT NAMACT Angela Parton The Thompson Group 12703 W State Road 32 acNNo, Ext): (765) 468-6655 I (Nc, No):(765) 468-7639 Parker City, IN 47368 noRIE : angela@thethompsongroup.net INSURED I INSURER B: Cincinnati Insurance Com DanV 110677 PEAK Elevator, LLC INSURER C : AI%2 5045 W 56th St INSURER D : Pinnacol Assurance Arvada, CO 80002 INSURER E INSURER F : r•nvGonr--Gc L`CDTICIt'ATC MI IMR=D- RFVICInM MI 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. INSR TYPE OF INSURANCE ADDL SUBRI POLICY NUMBER POLICY EFF POLICY EXPLIE LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE F—V7 OCCUR 04252017 05/03/2017 05/03/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PR MI E Ea occurrence 300,000 $ MED EXP (Any oneperson) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY jEeT LOC OTHER GENERAL AGGREGATE $ 10,000,000 PRODUCTS - COMP/OP AGG $ 4,000,000 GEN AGG PER ELE $ 4,000,000 B AUTOMOBILE LIABILITY ANY AUTO OWNED X SCHEDULED AUTOS ONLY AUTOS X HIRED X NON -AWNED AUTOS ONLY AUTOS ONLY 04252017 05/03/2017 05/03/2018 COMBINED SINGLE LIMIT Ea accident 1,000,000 $ BODILY INJURY Per n $ BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident $ $ C X UMBRELLA LIAR EXCESS LIAR X OCCUR CLAIMS -MADE C04252017 06/03/2017 05/03/2018 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DIED I X I RETENTION $ 0 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR/PARTNER/EXECUTIVE a FFICER/MEMBER EXCLUDED? ( andatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 4198225 05/03/2017 05/03/2018 X PTT TE ER E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE1 $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 7 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 Fort Collins N Mason St Fort Collins. CO 80522 ACORD 25 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: PEAKELE-01 LOC #: 1 PARAN1 AFRO ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED The Thompson Group PEAK W 56th St LLC POLICY NUMBER Arvada, CO 80002 SEE PAGE 1 CARRIER NAIC CODE EE PAGE 1 SEE P 1 EFFECTIVE DATE: SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance IF YOU ARE THE RECIPIENT OF THIS CERTIFICATE: ANY WORDING TO PROVIDE ADDITIONAL INSURED COVERAGE, PROVIDED COVERAGE ON PRIMARY AND NON-CONTRIBUTORY BASIS, OR PROVIDE A WAIVER OF SUBROGATION APPLIES ONLY WHERE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT. CONTRACTUAL LIABILITY COVERAGE IS ONLY PROVIDED TO THE EXTENT SET FORTH IN THE POLICIES AND MAY NOT COVER ALL LIABILITY ASSUMED BY THE NAMED INSURED UNDER THE CONTRACT. IF YOU ARE THE REQUESTOR OF THIS CERTIFICATE OF INSURANCE: THE THOMPSON GROUP HAS, UPON YOUR REQUEST, ISSUED THE ATTACHED CERTIFICATE OF INSURANCE. IF YOU HAVENT ALREADY DONE SO, WE HIGHLY RECOMMEND THAT YOU PROVIDE THE THOMPSON GROUP WITH A COPY OF THE INSURANCE AND INDEMNIFICATION PROVISIONS OF THE CONTRACT PERTAINING TO THE CERTIFICATE OF INSURANCE REQUEST SO THAT WE MAY PROPERLY ASCERTAIN WHETHER THE REFERENCED INSURANCE POLICIES ADDRESS THE LIMITS OF INSURANCE, TERMS AND TYPES OF COVERAGE REQUIRED BY THE CONTRACT. WHILE MOST CERTIFICATES OF INSURANCE CAN BE ISSUED AT NO COST, THE CONTRACT MAY REQUIRE THE PURCHASE OF ADDITIONAL INSURANCE COVERAE THAT COULD BE SUBJECT TO AN ADDITIONANL PREMIUM CHARGE. IN SOME INSTANCES, THE COVERAEIDENTIFIED IN THE CONTRACT MAY BE OUTSIDE THE UNDERWRITING GUIDELINES OF THE INSURANCE CARRIER AND CANNOT BE OBTAINED. ANY CONTRACT REVIEW PERFORMED BY THE THOMPSON ROUP SHOULD NOT BE CONSTRUED AS THE RENDERING OF LEGAL ADVICE OR A LEGAL OPINION CONCERNING ANY PORTION OF THE CONTRACT. THE THOMPSON ROUP HAS NOT ENDEAVORED TO IDENTIFY ALL POTENTIAL LIABILITY ISSUES THAT MIGHT ARISE UNDER THIS CONTRACT. THIS REVIEW IS PROVIDED FOR INFORMATION PURPOSES ONLY AND SHOULD NOT BE RELIED UPON BY THIRD PARTIES. ANY DESCRIPTION OF INSURANCE COVERAGE IS SUBJECT TO THE TERMS, CONDITIONS, EXCLUSIONS AND OTHER PROVISIONS OF THE POLICIES AND ANY APPLICABLE REGULATIONS, RATING RULES OR PLANS. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, NOR DOES IT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED THEREON. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD