HomeMy WebLinkAboutMILLERBERND MANUFACTURING COMPANY LLC - INSURANCE CERTIFICATE 2023-2024,4coRo�
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM!UO/YYYY)
aa�2a+2o2�
THIS CERTIFICATE IS 15SUED AS A MATTER OF INFQRMATI4N ONLY AND CONFERS NO RIGHTS 11PON THE GERTIFICATE HOLDER. TNIS
CER7IFICATE DOES NOTAFFIRMATIVELY OR NEGATIVELY AMEND, EXTEIYD ORALTER TNE COVERAGE AFFORDED BY THE POI.ICIES
BELOW. THIS CERTIFICATE OF INSURANCE DpES NOT CONS7ITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORI2ED
REPRESENTATIVE OR Pf20DUCER, AiJD TFiE CERTIFICATE HOLDER.
1MPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL lNSURED 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).
PRODl10ER i4AME: T JP Zimmerman and Tana Williamson
Hays Companies, Inc. PHo►+e {612) 333-3323 {612) 373-727U
AfC Mo Ext : A!C Mo :
SQ South 8ih Sireet aooR�ess: �PZimmerman@bbrown.com
SIIItQ 7OU INSURER�Sj AFFORDING CDVERAGE NAIC N
Minneapolis MN 55402 iNsuREe a: The Travelers Indemnity Company of America 25666
iksuReo iNsuREe e• The Travelers Indemnity Company 25658
Millerbemd Manu(aclurng Company, LLC
622 6ih 5treet S
P.O. Box 98
Y
Winsted MN 55395 I lNSURER F: I �_
COVERAGES CERTIFlCATE NUMB�R: 23-24 REVISION NUNEBER:
THIS IS TO CERTIFYTHATTHE POLICIES OF IiVSURRNCE LISTE� BELOW HAVE BEEN ISSUE� TOTHE INSURED NAMED ABOV� FOR THE POLICY PERIda
INDICATED. PlOTWlTt?STANbING ANY RE.^.UIR'c�r4ECST, TERM Q�, CC�fDI'ION QF ANY CONTRkC' GF2 (;THEiZ E30CUM�Mi WITi-I RE5F'EGT TO WFiICH THIS
CERTIFiCATE iVAAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES D�SCRIBEO HEREIN IS SUBJEC7 TOALL THE TERMS,
EXCLU51QIV5 AND C4NDITIONS OF SLCH POLICIE$. LIMITS SHOWN MAY WAVE BEEN REDUCE� BY PA D CLAIMS.
ILTR TYPE OF INSURANCE INS� WVU POLICY NUMBER MMlDDNYYY MMlODIYYYY LIMITS
x COMMERCIAL GENERAL I.IABILI7Y EACH OCCURRENGE y � ���O,OOO
CLAIMS-MAOE � OCCUR PREMISES Eaoocurcente y 300,000
A
GEiV'LAGGREGATE LIMITAPFLIES PER:
iG POLICY � PR� � �8G
JECT
OTiiER�
AUTOMOBILE LIABILITY
X ANYAUTO
g OWNE6 SCHEDULED
AUTOS OiYLY AVTOS
HIRE6 NON-OWNED
AUTOS ONLY AVTOS ONLY
X 11MBRELLA LlAB X OCCUR
CEXCESS LIAB ,,. ....� ..,,.,�
0
6308PQ59315
msuRER c:��velars Properiy Casualty Company ofAmerica 25674
iNsuAEce o: Great American Alliance Insurance Company 26832
051U112023 I 05101l2024
PROOUCTS - COMPlOP
Y
DEO /� RETENTION s 10,004
.KERS COMPENSATION
EMPL6YER5' LIABILITY Y 1 N
PRDPRIETORIPARTNERlFJ(ECUTIVE � � JA
cewnnE�reeR Excwoeo�
II yes, daspi6e ��ader
DESGRIPTIOhi O� OPERATIGNS celow
A Coniractors Equipment
Leased Equipment
BA8P095025
CUP4T929835
WCE5B746403
6308P059315
80DItY INJURY [Per person►
05101/2023 05/01/2024 BO�ILY INJURY (Per acddent�
U510112023 I 05IQ112024
0510112D23 � 05101I2p24 E �
MEO EXP fAnr one
@.i
05I01/2023 I 65101I2p24 i Limit
DESCRIPTION OF OPERAT10N5! LOCATIONS! VEHICLES {ACpAb 101, qddltlonal Remarks Schedule, may 6e atlaehed if more space Is requ3red)
Ciiy of Fort Collins is additional insured as respects general and automobile liability po�icies where required by written contract, subject to the policy terms
and conditions.
$59,486,590
CERTIFICATE HOLDER CANCELLATION .,
City Of Fort Collins
222 Laporle A�e
SHOUI.b ANY OF THE ABOVE �ESCRIBED POLICIES BE CANCELLE� BEFORE
THE EXPIRATION pATE THEREOF, NQTICE WILL BE �ELIVERED IM
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Fort Colhns
CC3 8U521
�
y 5,400
y 1.00O.U00
s 2.aoo.o00
z 2,000 000
S
a 1,000,000
S
E
S
S
15,000,000
- EA EMPLOYEE y 1,OUO,OOO
- NULICY LiMI f � S � •�CO,OUO
c�51988-2015 ACOR� CORPORATIpN, All rights reserved.
ACORD 25 (2016I03j The ACORD name and logo are registered marks of ACORD