Loading...
HomeMy WebLinkAboutTHE BAUEN CORPORATION - INSURANCE CERTIFICATE (12)ACORD, CERTIFICATE OF LIABILITY INSURANCE 10/1/2017 DATE(MMIDD/YYYY) 1 5/1/2017 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 Lockton Companies 8110 E Union Avenue Suite 700 Denver CO 80237 CONT CT NAME: A/C No Ext : (AIC, No): E-MAIL ADDRESS: INSURER AFFORDING COVERAGE NAIC # (303) 414-6000 INSURER A: Valley Forge Insurance Company 20508 INSURED The Bauen Corporation 1034092 801 E. 52nd Ave. Denver, CO 80216 INSURER B : Continental Casualty Company 20443 INSURER C : Pinnacol Assurance Company 41 190 INSURER D: AXIS Surplus Insurance Company 26620 INSURER E: INSURER F : COVERAGES BAUC003 CERTIFICATE NUMBER: 1991907 REVISION NUMBER: XXXXXXX --------------------- -------------- 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 LTR TYPE OF INSURANCE ADDL IN D SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR N N 4021109791 5/1/2017 5/1/2018 EACH OCCURRENCE 1,000,000 PREMISES Ea RENTED 100,000 MED EXP (Any oneperson) 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PE� LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMPIOP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO OWNAAUTOS ONLY AUTOSULEDBODILY AUTOS ONLY X AUTOS ONLDY N N 4021110598 5/1/2017 5/l/2018 COMBINED SINGLE LIMIT Ea accident $ 11000,000 BODILY INJURY (Per person) $ XXXXXXX Ix INJURY (Per accident $ XXXXXXX Peer acciden DAMAGE $ XXXXXXX $XXXXXXX B X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE N N 4021109807 5/1/2017 5/1/2018 EACH OCCURRENCE S 5,000 000 AGGREGATE $ 5,000,000 DED I I RETENTION $ $ }{j{XXXXX C WORKERS COMPENSATION AND EMPLOY RS'LIABILIITY YIN OFFAN YICER MEM ERPROPRIETOR/EXCLUDEDPARTNER/E? ECUTIVE N-] (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A N 2127630 10/1/2016 10/1/2017 X STATUTE °TH- ER E.L. EACH ACCIDENT $ I 000,000 E.L. DISEASE - EA EMPLOYEE 1,000,000 E.L. DISEASE -POLICY LIMIT 1,000,000 D PollutionLiability ff CP002398012017 5/1/2017 5/l/2018 Limit: $ 1.000,000 each claim Ded: $10,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1991907 AUTHORIZED REPRESENTATIVE City of Fort Collins P.O. Box 580 Fort Collins CO 80522 JJ C l ACORD 25 (2016/03) ©1 MOM: ORP(IIIIIII All rights reserved The ACORD name and logo are registered marks of ACORD