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HomeMy WebLinkAboutBIG HORN ROOFING INC - INSURANCE CERTIFICATE (6)BIGHORN-37 WEELMER ACORO CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 08/14/2017 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 Wendy Elmer NAME: PHONE (A/CC, No, Ext): (307) 233-8329 (A/c, No): Wyoming Financial Insurance 400 E 1 st St, Ste 105 W Casper, Y 82601 E-MAIL SS: welmer@weres.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Nationwide Mutual Insurance Company 23787 INSURED INSURER B : Allied Insurance Company of America 10127 INSURER C : AMCO Insurance Company 19100 Big Horn Roofing Inc. INSURER D : 605 S Adams Laramie, WY 82070 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 L TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM DD POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X X ACP3008312104 09/01/2017 09/01/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence 100,000 $ MED EXP (Any oneperson) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY �X JE� El LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY X X ACP3008312104 09/01/2017 09/01/2018 COMBINED SINGLE LIMIT $ 1,000,000 X BODILY INJURY Perperson) BODILY INJURY Per accident PROPER accident) $ C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE X X ACP3008312104 09/01/2017 09/01/2018 EACH OCCURRENCE $ 5,000,000 AGGREGATE 5,000,000 DED I I RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITYYIN ANY PROPRIETOR/PARTNER/EXECUTIVE❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below WA A ACP3008312104STOPGAP 09/01/2017 09/01/2018 PER X OTH- E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) When required by written contract or agreement, additional insured and waiver of subrogation applies under the General and Auto Liability performs AC7006 03/16 , CG7246 11115 (ongoing and completed operations) and CG7323 12/16. Coverage is primary and non contributory perform CG7323 12/16 and AC7006 03116. Copies of such forms are available upon request. Umbrella will follow form as respects additional insured and waiver of subrogation. City of Fort Collins PO Box 580 Fort Collins, CO 80522 a4 W-l1Lei ►1 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 I , l ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD