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HomeMy WebLinkAboutBALANCE POINT HEATING & AIR CONDITIONING - INSURANCE CERTIFICATE (2)Ac"RQ" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD(YYYY) 08/16/2017 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 CONTACT NAME: Pinnacol Assurance ....... —. _......_..__.................................................... PHONE FAX 7501 E Lowry Blvd A/C No. Ext : WC, No): Denver, CO 80230-7006 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Plnnacol Assurance ; 41190 INSURED INSURER B : Balance Point Heating & Air Conditioning 316 Commerce Drive INSURERC: Fort Collins, CO 80524 INSURER 0: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN !SSUED 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. IN§RT...... ............. .... ADDL SUBR POLICY EFF POLICY EXP.. _ TYPE OF INSURANCE LTR I I POLICY NUMBER MMIDD/YYYY MM/DD!YYYY L1Mfr5 COMMERCIAL GENERAL LIABILITY ;EACH OCCURRENCE S _._.—... ' i ......... ......}........................... .. .._ ! DAMAGE TO RENTED ....... ...... CLAIMS -MADE OCCUR PREMISES iEa occurnces $ re MED EXP (Any one person) S PERSONAL & ADV INJURY I $ GEN'L AGGREGATE LIMIT APPLIES PER: i GENERAL AGGREGATE $ PRO POLICY JECT LOC PRODUCTS - COMP!O�PAGG $ T _...... ......... _... .. OTHER: i '; $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 ............._........................... s................................................ .................. _... _... ANY AUTO BODILY INJURY (Per person) 5 �_. OWNED SCHEDULED --- - — -...........--..........- ......... BODILY INJURY (Per accrclent); $ AUTOS ONLY __ AUTOS I HIRED NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY f Per acadent) I S UMBRELLA LIAB OCCUR EACH OCCURRENCE S ............................................. EXCESS LIAB CLAIMS MADE .._ ........ .. ........ ................ AGGREGATE 1 S ..... ..... .. DED RETENTION S S WORKERS COMPENSATION PER OTH X ER j AND EMPLOYERS' LIABILITY Y/ N ,STATUTE __. i ANYPROPRIETCRIPARTNER/EXECUTIVE A Y❑ NIA i c L EACH ACCIDENT S 1,D00,000 41.16227 08/01/2017 108/01/2018 ;OFFICERMEMBEREXCLUC (Mandatory in NH) EL. DISEASE - EA EMPLOYEES $ 1,000,000 If yes, describe under --- -- 1 'DESCRIPTION OF OPERATIONS below ? ,��0,��0 j E.L. DISEASE - POLICY 'LrA11T $ i DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached if more space is required) Unless otherwise stated in the policy provisions, coverage is in Colorado only. Refer to the Acord 101 Additional Remarks Schedule for supplemental cancellation notification information. Excluded (If any) : Jamie Kusmik, William L Kusmik CERTIFICATE HOLDER CANCELLATION 1824444 City of Fort Collins PO Box 580 Fort Collins, CO 80525 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 Renaissance Insurance Group, LLC ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID LOC #: N/A N/A —'�-44 AC"R" ADDITIONAL REMARKS SCHEDULE Page 3 of 4 AGENCY Renaissance Insurance Group, LLC NAMED INSURED Balance Point Heating & Air Conditioning 316 Commerce Drive Fort Collins, CO 80524 POLICY NUMBER 4116227 CARRIER Pinnacol Assurance NAIC CODE 41190 EFFECTIVE DATE: 08/16/2017 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: Acord 25 (2016/0�ORM TITLE: Certificate of Liability Insurance SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO NOTIFY 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO NOTIFY SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. ACORD 101 (2008101) G 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD