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HomeMy WebLinkAboutLamp Rynearson, Inc. - Insurance Certificate l ® DATE(MM/DDIYYYY) AC40R O CERTIFICATE OF LIABILITY INSURANCE 9/21/202 f 1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. � �•� CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLI BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOR 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 FNIC NAME: Deanne Beltz-Sund P.O. Box 45279 A/c°N Ext:402-861-7191 FAX c No Omaha NE 68145 E-MAIL Deanne.Beltz@fnicgroup.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:XL Specialty Insurance Co 37885 INSURED LAM69437 INSURER B:Travelers Property Casualty of America 25674 Lamp R Inc. 14710 W.. Dodge Rd., Ste. 100 INSURER C:The Phoenix Insurance Co 25623 Dod Omaha NE 68154 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1776987258 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 I ADDL SUBR POLICY EFF POLICY EXP LTR' TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD LIMITS C X COMMERCIAL GENERAL LIABILITY Y 66021-971185 9/30/2023 9/30/2024 EACH OCCURRENCE $1,000,000 CLAIMS-MADE � OCCUR DAMAGES(RENTED PREMISES Ea occurrence) $500,000 MED EXP(Any one person) $10,000 PERSONAL 8 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY�JEST LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: _ __ _ _ _ _ $__ - C AUTOMOBILE LIABILITY Y 81021-974010 9/30/2023 9/30/2024 CO EaMBINED SINGLE LIMIT accident $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED id P BODILY INJURY(Per accent AUTOS ONLY AUTOS ( ) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ B X UMBRELLA LIAB X OCCUR CUP3L015816 9/30/2023 9/30/2024 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED X ! RETENTION$In nnn $ C WORKERS COMPENSATION UBBM969092 9/30/2023 9/30/2024 X I PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE T7ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICER/MEMBEREXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 A Architects/Engineers DPR5018664 9/30/2023 9/10/2024 Each Claim $5,000,000 Professional Liability/Pollution Aggregate $5,000,000 Claims Made Basis i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of Fort Collins,its officers,agents and employees are additional insured for general liability and automobile liability if required by written contract executed prior to loss. 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. Purchasing Division P.O. Box 580 AUTHORIZED REPRESENTATIVE Fort Collins CO 80522 1//�_ 4 nK C— ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ,acoRO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1 9/25/202 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLI BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOR 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 FNIC PHONE Deanne Beltz-Sund FAx P.O. Box 45279 AIc No EXt:402-861-7000 AIc No): Omaha NE 68145 ADDRESS: Deanne.Beltz@fnicgroup.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:XL Specialty Insurance Co 37885 INSURED LAMPRYN-02 INSURER B:Travelers Property Casualty of America 25674 Lamp Rynearson, Inc. 14710 W. Dodge Rd.,Ste. 100 INSURER C:The Phoenix Insurance Co 25623 Omaha NE 68154 INSURER D:Charter Oak Fire Insurance Co. 25615 INSURER E: _ INSURER F: COVERAGES CERTIFICATE NUMBER:801437908 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 TYPE OF INSURANCE ADDL.SUBR POLICY EFF POLICY EXP LIMITS LTR D'WV POLICY NUMBER MMIDD/YYYY MMIDD D X COMMERCIAL GENERAL LIABILITY Y 66021_971185 9/30/2024 9/30/2025 EACH OCCURRENCE $1,000,000 DAMAGE To RENTED CLAIMS-MADE FxI OCCUR PREMISES Ea occurrence) $500,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY�PECOT- LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ C AUTOMOBILE LIABILITY Y 81021_974010 9/30/2024 ! 9/30/2025 1 COMBINED a accidentSINGLE LIMIT $1,000,000 E X ANY AUTO I BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident B X UMBRELLA LIAB X OCCUR CUP31_015816 9/30/2024 9/30/2025 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED X I RETENTION$1 rinn $ C WORKERS COMPENSATION UB8M969092 9/30/2024 9/30/2025 X I PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICER/MEMBEREXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 A Architects/Engineers DPR5034591 9/30/2024 9/30/2025 Each Claim $5.000,000 Professional Liability/Pollution Aggregate $5,000,000 Claims Made Basis DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of Fort Collins,its officers,agents and employees are additional insured for general liability and automobile liability if required by written contract executed prior to loss. 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. Purchasing Division P.O. Box 580 AUTHORIZED REPRESENTATIV Fort Collins CO 80522 / G' ©1�99888-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD