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HomeMy WebLinkAbout5280 Electrical - Insurance Certificate AC"RD® CERTIFICATE OF LIABILITY INSURANCE DATE(MNUDD/YYYY) 9/18/2023 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 have ADDITIONAL INSURED 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). PRODUCER CONTACT Arthur J. Gallagher Risk Management Services, LLC NAME: 10901 W. 120th Ave ac°.No.Ext•303-444-4666 E-MAIL (A/C Nor 303-444-8481 Suite 100 el ADDRESS: JIII Barlon AJG.com Broomfield CO 80021 INSURER(S)AFFORDINGCOVERAGE NAIC_8 INSURER A:Selective Way Insurance Company 26301 INSURED 5280ELE-01 INSURER B:Selective Insurance Company Of America 12572 5280 Electrical 6859 Galapago Court INSURER C: Denver, CO 80221 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:2045964317 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 ADDL UBR — -- LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP — ---- -- - MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY S2503128 8/15/2023 8/15/2024 EACH OCCURRENCE CLAIMS-MADE $1,000,000 OCCUR PREMISES Ea occurrence) $500,000 MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 X POLICY❑PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG $3,000.000 OTHER: I $ A AUTOMOBILE LIABILITY S2503128 8/15/2023 8/15/2024 CO MBINEDSINGLELIMIT $1.000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ X OWNED SCHEDULED _ AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ A X UMBRELLALIAB X OCCUR S2503128 8/15/2023 8/15/2024 EACH OCCURRENCE $4,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE _ $4,000,000 DED RETENTION$ B WORKERS COMPENSATION WC 9076342 8115/20 33 8/15/2024 X PER OTH- $AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICE R/MEMBEREXCLUDED? N/A E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. 281 N. College Ave. Fort Collins CO 80524 AUTHORIZED REPRESENTATIVE USA 9�;7 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD