HomeMy WebLinkAboutFARNSWORTH GROUP INC - INSURANCE CERTIFICATE 2020-2021 (2)pATE �MMIDOIYWY)
A`ORo� CERTIFICATE OF LIABILITY INSURANCE s�sl�2azo
THIS CERTIFICATE IS 15SUEd AS A MATTER OF INFORMATION pNLY ANp CONFERS NO RIGi1TS UPON THE GERTIFICATE HOLDER. TH15
GERTIFIGATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAG@ AFFORdED BY THE POLIGIES
BELOW. TH1S CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER{5J, AU7HORfZED
REPRESEN7ATIVE OR PROOUCER, AND THE CEItTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the palicy(ies) must ha�e AdD1710NAL INSU3tEU pravislons or be endorsed.
If SUBROGATION IS WAiVED, su6ject to the terms and conditlons of the policy, certaln pvlicies may requlre an endorsement. A statement on
this certificate does not confer rights to the cert[ficate holder tn lieu of such encforsement(s).
PRODUCER �
NAME;
Cottingham & Butfer PHONE Fnx
Robert Heath � 563-5s7-5oo0 ,vc no : 563-583-7339
B00 Main St. a na��ss:
Dubuque IA 5200'f INSURERISi QFFBRDING COVERAGE NAIC il
INSURED
Famsworth Group, Inc.
2709 McGraw Drive
Bloomington IL 61704
INSURER b :
19682
of America 25674
COVERAGES CERTIFICA�E NLIMBER:2U21525343 REVISION NUMB�R:
THIS IS TO CERTIFY THAT THE PO�ICIES OF INSURANCE LIS7�0 BELOW HAVE BEEN ISSUED TO iHE IIVSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NONIITHSTANDING ANY REQUIREMENT, T�RM pR GONDITION QF ANY CONTRACT OR O7HER DOCi1MENi WI7H RESPECT TV WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PER7AIN, THE INSURANCE AFFQRDED BY TiiE POLICIES QESCRIBE❑ HEREIN IS SLtBJECT TO ALL TH� 7�RMS,
EXCI.USIQIVS AiVp CONRITIOIVS OF SUCH PO�IGIES LIMITS SHOWN MAY HAVE B�EN REDUCED BY PAID CLAIMS.
HSR TypE OF INSl1RANCE R�DL SUBR pOLICY NlIM6ER MMlDDlYYYY MMlDDJYYYY LIMtTS
LTR
A X COMM�RCIALGENERALLIABII.ITY 83 UEId OB 8121 A1112020 411.+2021 Ep,CHOCCURRENCE S 1,Ob0000
CLAIMS MAOE I%� � OCCUR PREMISES Ea accurtence S 300,U60
GEAI'L AGGREGATE LIMIT APPLIES PER
POLICY CX I JECS �X,� LOC
OTHER:
A AUTOM061LELIA6itITY
X ANY AUTO
OWNED SCHE�ULEO
AUTpS ONLY AUTOS
HIRFD t�lOM-OWNEO
AUTOS ONLY AUTOS OIVLV
B X UMBRELLA LIAB X OGGUR
EXCESS LIAB C�,qIMS-MAOE
OE� RETEiJTION E
C WORKERSCOMPENSATION
AhD EMPLOYERS' EIABILITY Y! N
ANYPROPRIETORIPARTNERlEXECUTIVE ❑
OFFICERIMEMB�R EXCI.UDE�? N 1 A
4.��+2a�o j 4,�r�q�1
MED EXP [M one persan) E 1
PERSONAL & ADV INJURY 5 '�
GENERALAGGREGATE E2
5
COM INED $INGLE IIMIT � 1 �p00,000
Ea accident
BODILY INJURY (Per person] E
BppILY 1NJURY (Per accidenlj S
PROPERTYDAMAGE s
Per aecidenl
S
4+1�Y02p 4�1�7p77 E,qCiiOCCUF
AGGREGATE
4,'1;7R24 I 4H12Q21
E.L. EACH ACCIDSNT
E.L. �ISEASE - EA EM
INSURERA: !'1aRTOfO I
€aRN �k0-O5 �NSURER B : TfBVeI@�S
8�iJ EN�B8122
ZUP-61M7i617
83 WE 088G4H
000
E 1,000,000
a i,aoo,oaa
s �.aoo nno
DESCitIPTIDk OF OPERATION51 LOGATIONS ! VEHICLES �ACOR� 101, Addilional Remarkn Schedule, may 6e atlached if more apace Is requiredj
FTC
Famsworth Group, Inc. Qroject Manager Eric Cluver
The City of Fort Collins, iks a�cers, agents, and employees are additional insured on the General Liability and Auto Liability policies per written contract
between the named insured and the certificate holder that requires such a status sub ect ta the terms and conditions of the endorsement attached to lhe policy.
A 3Q-day notice of cancellation is provided by lhe insurance company to the certFfrcate holder as autlined by the endorsement attached to the General Liability
policy.
CERTIFICATE MOLDER CANCELLATION
The City oi Fort Collins
P.O. Box 580
215 N Mason
Fort Collins CO 80522
SHOULD ANY OF THE ABOVE DESCRIBEQ POLICIES BE CANCELLE� BEFQRE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED lN
ACCORDANCE WITH THE POLICY PROVISIONS.
REARESENTATIVE
ACORD 25 {2Q16I03)
U 99Sil-Z075 A4UItU [:C}KF'UKA I It11V. AI! CIgIILS i@SBfVe
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