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HomeMy WebLinkAboutMOUNTAIN CONSTRUCTION & MANAGEMENT CO DBA ROOF WOR - INSURANCE CERTIFICATEDATE (MM/DD/YYYY) ACOREP CERTIFICATE OF LIABILITY INSURANCEF`.� 12/20/2017 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 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 endorsements . PRODUCER CONTACT Pam Thompson NAME: P Moody Insurance Agency, Inc. PHICN� (303)824-6600 FACNo:(303)370-0118 8055 East Tufts Avenue E-MAIL ADDRESS: son@mood ins.com ADDRESS: PamP y Suite 1000 INSURERS AFFORDING COVERAGE NAIC # Denver CO 80237 INSURERA:United Specialty Ins Co 12537 INSURED INSURERB:Westfield Insurance 24112 Mountain Construction & Management Company, Denver INSURERC:Pinnacol Assurance 41190 _ Division DBA Roof Worx LLC INSURERD: 12301 N Grant Street Suite 130 INSURERE: Thornton CO 80241 INSURER F : COVERAGES CERTIFICATE NUMBER_18-19 with forms 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 EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDD MM D X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE [ X1 OCCUR PRE M MISEa occurrence $ 50,000 MED EXP (Any one person) $ EXCLUDED ATNATL1830878 1/1/2018 1/1/2019 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 , 000 , 000 POLICY JE EI LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea ccident a $ 1,000,000 BODILY INJURY (Per person) $ B X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS CWP8774952 1/1/2018 1/1/2019 BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ NON -OWNED X HIRED AUTOS X AUTOS Medical payments $ 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- X STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1 000 000 C FM (Mandatory in ( ry " ) NIA 4078218 2/1/2017 2/1/2018 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below I I I E.L. DISEASE - POLICY LIMIT $ 1,000,000 B CONTRACTORS EQUIPMENT ATNATL1830878 1/1/2018 1/1/2019 BLANKET LEASED/RENTED $50 , 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) rF:PTIFIrATF Hrl1 nPIQ rANrI=1 I ATInN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 281 N College Ave ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80526 Pam Thompson/PAMTHO ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)