|
m Helen Reid CIC CISR FaxID Mountain West Ins. Date.711912022 1 45-02 PM Paoe 1 of T
<br /> BOWEBRO-05 ELENR
<br /> CERTIFICATE OF LIABILITY INSURANCE °ATE191202YYY'
<br /> 719l2022
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> ........_... ... ................... ......... . .......... _.. .............._......_..._. .....................-..........................-............._.- ...-,-,,,, -....._......... ............
<br /> IMPORTANT: if the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
<br /> this certificate does not confer rights to the certificate holder in lieu of such endorsements.
<br /> PRODUCER c cT Helen Reid,CIC, CISR
<br /> Mountain West In&Fin Sery LLC PHONE FAX
<br /> 100 E Victory Way Arc,No,Exl: 970 765.7153 A1C,No 970 824.8188
<br /> Craig,CO 81625 %k S&helenr@mtnwst.com
<br /> ..._.........................__.INSURER(S).AFFOROINC COVERAGE ... - ....... NAIL p
<br /> INSURER A,National American Insurance CO 23663
<br /> ... ... .. .................... ..
<br /> -
<br /> INSURED IN5URERB.Pinnacol Assurance 41190
<br /> Bower Brothers Construction,Inc, ,INSURER C _ --_— -mm
<br /> 595 Taylor St. INSURER O,
<br /> Craig,CO 81625 "
<br /> INSURER E:
<br /> INSURER F
<br /> COVERAGES_.-......_......- .. CERTIFICATE NUMBER: . _ ..-.. . ..........REVISLON NUMBER,---_-..._
<br /> THIS IS TO CERTIFY THAT THE POLIC ES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AI-L THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
<br /> Ik9R -- ---- ADDL SUER - .-........._-._ ��.POLICY EFF POLICY EXP — ....... . . ........_..— --
<br /> TJEL TYPE OF INSURANCE [f - POLICY NUMBER_ ___ _LIMITS
<br /> _—..._..------..._. —.._..-... tkMIRDrYYYYJ 1]OdfYY _
<br /> A X COMMERCIAL GENERAL LIABILITY EACFt!OCCURRrzNCF S 1,000,000
<br /> .. DAMAGE 70 RENTED 100,000
<br /> _J CLAIMS-MADE OCCUR X XMP24560205 1112fi12021 11l2612022 I aiEa S
<br /> MED EXP IAny one perwn,],._ S _ 10,000
<br /> .. PERSONAL 8 ADV 191 RY.... S.. 1,000,000
<br /> --
<br /> rF.N'LAGGREGATE LIMIT APPLIESPEFk GENERAL AGGREGATE S 2,000,000
<br /> X POLICY E]pm F cOC PRODUCT S-COMPrOPAGG S 2,00%000
<br /> E.OTHER S _
<br /> A ' AUTOMOBILE LIABILITY ..... . - .. ... ..._�.��-.. .. .-. - 1.000,000
<br /> COMBINED SINGLE LI641T
<br /> {EaaulnepU. s—...
<br /> X ANY AUTO __ X X MP24560205 11I2612021 11/26/2022 SCHEDULED -.BODILY INJURY IPcr per gnk
<br /> OWNF4
<br /> AI,F'rL}S QNLY AUpQTGpQ+'4 BODILY INJURY(Per auc:den! S
<br /> A�ONLY ALjTQB{}Nr[� PSOAPr DAMAGE ..
<br /> UMBRELLA LIAR X OCCUR EACH OCCURRENC S 5.000,000
<br /> X EXCESS LIAB , CLAIM$-MADE X X MB56150205 11126/2021 1112612022 AGpREGATE g 5.000,000
<br /> DE t} RETENT(Q115 _.........W.,.,,._._.. S
<br /> WORKERS COMPENSATION X PER C OTH•
<br /> 4N0 EMPLOYERS'LIABILITY YIN STAFUIE
<br /> ANY PROPRIETORVAOTNpi2 Xt:CL1TIYE' X 4013254 8!1l2022 8l112023 --- 1,000,000
<br /> p FwER.7N�AlBEER EX,7^ tJt7E YJ kJ A F L EACH a LyIItJT_-_—_. S
<br /> ( aAt%,M n NH) E L DISEASE-EA EMPLOYEES 1,000,000
<br /> If acs7 be lnrle+r .. .---t----
<br /> . -.. D R'D 7pN 0P Oi}ERA*II NS4 bel8w E.L DISEASE-POL,CV LIMIT 1.000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS r VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required)
<br /> Certificate Holder is an additional insured on the general liability and automobile liability where required by written contract.The general liability,automobile
<br /> liability and workers'compensation contain r t f gatiovor of Certificate Holder.The General Liability policy includes Contractual Liability.
<br /> Coverage is primary and non-contributory c rm.30 day notice of cancellation Is provided.
<br /> JUL 2 0 2022
<br /> ..E - lVr5ID14-01 EC A�IAYI O N,
<br /> ---..._............ _.._. _. .... .
<br /> CERTIFICATE HOLDER C ELATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> State of Colorado THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Division of Reclamation,Mining and Safety
<br /> 1313 Sherman St.,#215 .............._
<br /> Denver,CO 80203 AUTRORIZED REPRESENTATIVE
<br /> I -1%'cl—
<br /> ........ ..................1 - -
<br /> ACORD 25(2016103) 0 1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
|