DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
8/16/2016
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). CONTACT Brandie Zuckerman, CRIS NAME: FAX PHONE (303)824-6600 (A/C, No): (303)370-0118 (A/C, No, Ext): E-MAIL ADDRESS:
[email protected]
PRODUCER
Moody Insurance Agency, Inc. 8055 East Tufts Avenue Suite 1000 Denver CO 80237
INSURER(S) AFFORDING COVERAGE
Specialty Underwriters INSURER B :Cincinnati Indemnity Company INSURER C :Pinnacol Assurance
INSURED
Valiant Contractors, Inc. 5195 W. 58th Ave. Unit F Arvada CO 80002
13037 23280 41190
INSURER D : INSURER E : INSURER F :
CERTIFICATE NUMBER:16-17 Master
COVERAGES
NAIC #
INSURER A :Cincinnati
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 LTR
TYPE OF INSURANCE
X A
ADDL SUBR INSD WVD
POLICY NUMBER
POLICY EFF POLICY EXP (MM/DD/YYYY) (MM/DD/YYYY)
COMMERCIAL GENERAL LIABILITY CLAIMS-MADE
X
OCCUR
CSU0087351
7/27/2016
7/27/2017
GEN'L AGGREGATE LIMIT APPLIES PER: PROX POLICY LOC JECT
LIMITS
EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence)
$
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
PRODUCTS - COMP/OP AGG
$
COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person)
AUTOMOBILE LIABILITY
B
ANY AUTO ALL OWNED AUTOS HIRED AUTOS
1,000,000 50,000 10,000 1,000,000 2,000,000 2,000,000
$
OTHER:
X
$
SCHEDULED AUTOS NON-OWNED AUTOS
ENP0397112
7/27/2016
7/27/2017
$
1,000,000
$
BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident)
$ $
X B
C
UMBRELLA LIAB EXCESS LIAB
X
OCCUR
EACH OCCURRENCE
$
CLAIMS-MADE
AGGREGATE
$
X RETENTION $ 10,000 DED WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE N/A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below
ENP0397112
7/27/2016
7/27/2017
$
X
PER STATUTE
OTHER
E.L. EACH ACCIDENT
4168042
10/1/2015
10/1/2016
1,000,000
$
E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT
$
1,000,000 1,000,000 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER
CANCELLATION
**For Information Only**
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
B Zuckerman, CRIS/BRA ACORD 25 (2014/01) INS025 (201401)
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