HomeMy WebLinkAboutCUSTOM AIR INC - INSURANCE CERTIFICATE (5)Client#: 33379 CUSAIRPC
DATE (MM/DD/YYYY)
ACORDT. CERTIFICATE OF LIABILITY INSURANCE 1 9/25/2017
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 endorsement(s).
PRODUCER CONTACT
NAME: Laura Leovic
Holmes Murphy Colorado PHCONEFAxp y " No Ext ; 720-622-8243 ac No ; 855-534-8896
7600 East Orchard Rd, Ste 330 South E-MAIL s, Ileovic@holmesmurphy.com
Greenwood Village, CO 80111 INSURER(S) AFFORDING COVERAGE NAIC#
INSURER A: Firemens Insurance Company of W 21784
INSURED INSURER B : Pinnacol Assurance Company 41190
Custom Air, Inc. INSURER C: AGCS Marine Insurance Company 22837
3910 South Decatur Street
INSURER D
Englewood, CO 80110
INSURER E
INSURER F :
CnVFRAGFR CFRTIFICATF NIJMRER! 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 CONTRACTOR 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 ADDLSUBR LI POCY EFF POLICY EXP
LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYY MM/DD LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE 7 OCCUR
PD Ded:$500
CPA310954727
10/01/2017
10/01/2018
EACH OCCURRENCE
$1 000 000
PREMISES Ea occur, ence
$ 300,000
X
MED EXP (Any one person)
$10 000
PERSONAL & ADV INJURY
$1 000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRO. F7
POLICY L^ 1 JECT LOC
OTHER:
GENERAL AGGREGATE
$2,000,000
PRODUCTS - COMP/OP AGG
$2,000,000
$
A
AUTOMOBILE LIABILITY
X ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
X HIRED AUTOS X AUTOSNON-OWNED
CPA310954727
10/01/2017
10/01/201
Eccd OaaeDSINGLELIMIT
1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
de tD
P OacEcRAMAGE
$
A
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
CPA310954727
10/01/2017
10/01 /201
EACH OCCURRENCE
s8,000,000
AGGREGATE
s8,000,000
DED X RETENTION $O
$
B
AND EMPLOYERS' LIABILITY WORKERS COMPENSATION
ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N
OFFICER/MEMBER EXCLUDED? N
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N I A
4061749
10/01/2017
10/01/201
X PTRT T ORH
E.L. EACH ACCIDENT
$1 00O 000
E.L. DISEASE - EA EMPLOYEE
$1 OOO 000
s1,000,000
E.L. DISEASE - POLICY LIMIT
C
C
Leased/Rented Eq
Installation Fit.
SML93068983
SML93068983
10/01/2017
10/01/2017
10/01/201
10/01/201
$50,000; $1,000 Ded
$150,000; $1,000 Ded
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE
City of Fort Collins
P.O. Box 580
Fort Collins, CO 80522
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
VlM" 1/'V+'oe,
@ 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S307370/M307118 ACEK1