HomeMy WebLinkAboutMARSHALL BROTHER CONSTRUCTION DBA G2 ROOFING - INSURANCE CERTIFICATEACOR" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY)
09/20/2017
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 Bonnie Dyson
Stailey Insurance Corporation PHONE FAX
2084 S. Milwaukee Street (ac,No�___(303)759-2796 .(303)759 2960
Denver CO 80210-
E-MAIL bonnie@staileycorp.com
INSURED
Marshall Brothers Construction, LLC dba:
G2 Roofing
6920 S. Jordan Road, Suite H
Englewood CO 80112-
Mesa Unerwriters Specialty Insurance 136838
Pinnacol Assurance 141190
ran\/GRAnFc CERTIFICATE NIIMRFR• RFVISION Nr1MRFR-
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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR
B
X
COMMERCIAL GENERAL LIABILITY
,j CLAIMS -MADE OCCUR _i OCCUR
_
X
MP00050033001668
09/27/2017
9/27/2018
EACH OCCURRENCE
DAMAGE TO RENTED
.-PREMISES ..(Ea_occurren
1,000,000
100,000
GE_N'L
17-1
MED EXP (Any oneperson)
$ 5,000
PERSONAL & ADV INJURY
1,000,000
AGGREGATE LIMIT APPLIES PER:
POLICY L1 ._ ECOT- L� LOC
OTHER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS -COMP/OP AGG
2,000,000
$
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
~_ AUTOS AUTOS
NON -OWNED
HIRED AUTOS AUTOS
COMBINED SINGLE LIMIT
a accident
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTYDAMAGE
$
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
AGGREGATE
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION F OPER T N w
NIA
4195907
10/01/2017
10/0121
X PER orH-
E.L. EACH ACCIDENT
500,000
E.L. DISEASE - EA EMPLOYEE
$ 500,000
500,000
E.L. DISEASE - POLICY LIMIT
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER (:ANL;tLLAI IUN ^'
City of Fort Collins
P.O. Box 580
Fort Collins
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
CO 80522- AUTHORIZED REPRESENTATIVE
+ V
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