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HomeMy WebLinkAboutFOUR SEASONS HEATING INC - INSURANCE CERTIFICATE (2)FOURS-4 OP ID: E1 AcoRO CERTIFICATE OF LIABILITY INSURANCE `---�' DATE 12/(22//0162016 Y) 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 endorsement(s). PRODUCER Brown & Brown of Colorado, Inc 2170 S. Parker Rd Ste 251 CONTACT Evie Jo Ontiveros PHONE 720-963-4286 FAX A/c No Ext : A/C, No): 720-962-5142 E-MAIL ADDRESS: eontiveros@bbdenver.com Denver, CO 80231 Jason Sartor INSURERS AFFORDING COVERAGE NAIC # INSURER A:SECURA Supreme Ins Company 10239 INSURED Four Seasons Heating Inc INSURER B : Pinnacol Assurance Company 41190 Jay Lauhon 4896 Marshall St INSURER C : United Specialty Ins. Co. 12537 Wheat Ridge, CO 80033 INSURER D : 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 LTR TYPE OF INSURANCE ADDL UB POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS C X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE T OCCUR X ATN-ATL1740060 01/01/2017 01/01/2018 DAMAGET( RENTED PREMISES ERoccurrence $ 50,00 MED EXP (Any one person) $ 5,00 X $10,000 ded/occ PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY ECT F1 LOC PI PRODUCTS -COMP/OP AGG $ 2,000,00 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,00 X _ BODILY INJURY (Per person) $ A ANY AUTO A3231792 01/01/2017 01/01/2018 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAB DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A 4055092 01/01/2017 01/01/2018 PER OTH- X STATUTE I I ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,00 A Auto Phy Damage A3231792 01/01/2017 01/01/20111 Comp Ded .50- Coll Ded 50 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) PEr policy terms conditions & exclusions Certificate Holder is an Additional Insured as respects General Liability, as required by written contract. Email: kmathea@fcgov.com GtK 1 It-IUA I t t1ULUtK (:ANUtLLA I IUN FTCUTIL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Kaye Mathea PO Box 580 AUTHORIZED REPRESENTATIVE Ft Collins, CO 80522 l V �, © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD