HomeMy WebLinkAboutA and A Quality Appliance Inc - Insurance Certificate 2024-2025 AC" DATE(MM/DD/YVYY)
CERTIFICATE OF LIABILITY INSURANCE D„23,2O24
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 an this
certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER TACT
NAME: CLIENT CONTACT CENTER
FEDERATED MUTUAL INSURANCE COMPANY
HOME OFFICE:P.O.BOX 328 1n/cNMNo,Eat):888-333-4949 n/c,No):507-446-4664
CNJATONNA,MN 55060 ADORESs:CLIENTCONTACTCENTER FEDINS.COM
INSURERS AFFORDING COVERAGE NAIC#
INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935
INSURED 380-922-5 INSURER B:
A AND A QUALITY APPLIANCE INC INSURER C:
321 W 84TH AVE
THORNTON,CO 80260-4814 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:803 REVISION NUMBER:0
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 INSR ADOLI WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000
CLAIMS-MADE ❑X OCCUR DAMAGE TO RENTED PREMISES $100,000
MED EXP(My one person) $10,000
A N N 9850458 02/01/2024 02/01/2025 PERSONAL&ADV INJURY $i,000,000
GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
X POLICY �ECo- ❑LOC PRODUCTS&COMP/OP AGG $2,000,000
OTHER:
AUTOMOBILE LIABILITY COMBII�IED SINGLE DMIT $1,000,000
Es acclden
JANYAUTO BODILY INJURY(Per Person)
AOWNED AUTOS ONLY 3AUTOEDULED N N 9850458 02/01/2024 02/01/2025 BODILY INJURY(Per AccidenQ
HIRED AUTOS ONLY NAOTN�ouED PROPERTY DAMAGE
LY
X UMBRELLA LIAB ICLAIMS-MADE
OCCUR EACH OCCURRENCE $10,000,000
A EXCESSLIAB N N 9850460 02/01/2024 02/01/2025 AGGREGATE $10,000,0()0
DED I RETENTION
WORKERS COMPENSATION PER STATUTE OTHER
AND EMPLOYERS'LIABILITY YIN
ANY PROPRIETOR/PARTNERI EXECUTIVE E.L EACH ACCIDENT $1,000,000
A OFFICERIMEMBEREXCLUDED? N/A N 9850458 02/01/2024 02/01/2025
(Mandatory In NH) E.L DISEASE EA EMPLOYEE $1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $1,000,000
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is reQuired)
SEE ATTACHED PAGE
CERTIFICATE HOLDER CANCELLATION
2-5 8030
CITY OF FORT COLLINS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
CITY
424 W MULBERRY ST BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
FORT COLLINS,CO 80521
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE - d
0 19W-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: 380-922-5
ADDITIONAL REMARKS SCHEDULE Page 1 of 1
AGENCY NAMEDINSURED
FEDERATED MUTUAL INSURANCE COMPANY A AND A QUALITY APPLIANCE INC
321 W 84TH AVE
POLICY NUMBER THORNTON,CO 80260-4814
SEE CERTIFICATE#803.0
CARRIER TNAIC CODE EFFECTIVE DATE:SEE CERTIFICATE#803.0
SEE CERTIFICATE#803.0
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE
SECONDARY POLICY(S)
Workers Compensation N/A N 9850459 02/01/2024 02/01/2025 WC STATUTORY LIMITS YES
E.L. EACH ACCIDENT $1,000,000
E.L. DISEASE-EA EMPL 51,000,000
E.L. DISEASE-POL LIMIT $1,000,000
EL N/A N 9850459 02/01/2024 02/01/2025 WC STATUTORY LIMITS YES
E.L. EACH ACCIDENT $1,000,000
E.L. DISEASE-EA EMPL $1,000,000
E.L. DISEASE-POL LIMIT 91,000,000
STOP-GAP (EMPLOYER'S LIABILITY) COVERED STATE(S) OH
STOP-GAP (EMPLOYER'S LIABILITY) COVERED STATE(S) OH
ACORD 101 (2008101) O 2008 ACORD CORPORATION.All rights reserved.
The ACORD name and logo are registered marks of ACORD