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HomeMy WebLinkAboutBUILDER SERVICES GROUP INC DBA MATO - INSURANCE CERTIFICATE (8)A�RD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/2017 YY> osn z/zo17 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 Aon Risk Services Central, Inc. Southfield MI office CONTACT NAME: PHONE (866) 283-7122 FAX (800) 363-0105 (A/C. No. Ext): (A/C. No.): E-MAIL ADDRESS: 3000 Town Center Suite 3000 Southfield MI 48075 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Old Republic Insurance Company 24147 Builder Services Group, Inc. d/b/a Mato A Topeuild Company INSURER B: ACE American Insurance Company 22667 INSURER C: Lloyd's syndicate No. 1969 AA1120106 INSURER D: 4850 Lima Street Denver CO 80239 USA INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570066866718 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. Limits shown are as requested 1 TR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY 1 4 EACH OCCURRENCE $2,000,000 CLAIMS -MADE X❑ OCCUR DAMAGE TO RENTED PREMISES Ea occurrence S2,000,000 MED EXP (Any one person) $25 , 000 PERSONAL &ADV INJURY $2,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4 , 00O , OOO X POLICY ❑ JECT PRO- PRODUCTS - COMP/OP AGG $4,000,000 OTHERElLOC : A AUTOMOBILE LIABILITY MWTB 310454 06/30/2017 06/30/2018 COMBINED SINGLE LIMIT Ea accident $S , OOO, OOO BODILY INJURY ( Per person) X ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident) AUTOS ONLY AUTOS HIRED AUTOS NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE Per accident) C X UMBRELLA LIAB X OCCUR CSUSA1701330 06/30/2017 06/30/2018 EACH OCCURRENCE $2,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $2,000,000 DED I RETENTION B B WORKERS ORKE SCOMPPEELSATION AND EMPLOITY YIN ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) NIA WLRC48032461 All Other States SCFC48032473 WI Only 06/30/2017 06/30/2017 06/30/2018 06/30/2018 X SPR TATUTE ERH E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF Ooc Rp.T!0NS be!cw E.L. DISEASE -POI. ICY LIMIT $1,000,000 B Excess WC WCUC48032485 06/30/2017 06/30/2018 EL Each Accident $1,000,000 WA Only EL Disease - Policy $1,000,000 SIR applies per policy ter s & condi ions EL Disease - Ea Emp $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: City of Fort Colling Fleet Maintenance Shop, 835 wood St., Fort Collins, CO 80522, PO Number: 9146215, vendor Number: 541170. CERTIFICATE HOLDER City of Fort Colling Operations Services Attn: Nick 3ovene Bldg B 300 Laporte Ave Fort Collins Co 80521-2719 USA 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. AUTHORIZED REPRESENTATIVE L- TicC-� 0 m `m tom. d d 0 2 00 O Z tv R U w t: 0) L) ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD