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HomeMy WebLinkAboutECONOLITE CONTROL PRODUCTS - INSURANCE CERTIFICATE (5)ACORQM CERTIFICATE OF LIABILITY INSURANCE 0DATE 4129/4129/MIDD/YY) 04 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Armstrong/Robitaille Bus&InsSv ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 680 Langsdorf Drive #100 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO Box 34009 Fullerton, CA 92834-9409 INSURED Econolite Control Products, Inc. California Chassis, Inc 3360 E. La Palma Avenue Anaheim, CA 92806 COVERAGES INSURERS AFFORDING COVERAGE INSURER A: Federal Ins. Co/Chubb F ER E: 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR -- - POLICY TI EFFECTIVE POLICY EXPIRAON LTR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY LIMITS A GENERAL LIABILITY X COMMERCIALGENERAL LIAGILITY CLAIMS MADE '_ X OCCUR GEN'L AGGREGATE LIM IT APPLIES PER: POLICY X PEOT X LOC 35818716 04/27/04 04/27/05 EACH OCCURRENCE $1,000,000 FIRE DAMAGE (Any we fire) $1,000,000 MED EXP (Any one person) _ $10 1 000 PERSONAL & ADV INJURY $1 000 000 GENERAL AGGREGATE s2,000,000 PRODUCTS -COMP/OP AGG $1,000,000 - -- - A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 73215072 04/27/04 04/27/05 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO — AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ _. $ EXCESS LIABILITY OCCUR n CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ - _ $ - $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY WC STATU- OTH- _ iTORY LIMITS R -.--- E.L. EACH ACCIDENT ----- $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS The City of Fort Collins, its officers, agents are named as Additional Insured, as respects general liability,as required by written contract per form 17023080-0401 attached. City of Fort Collins, CO Attn: Mr. James B. O'Neil, III P.O. Box 580 Fort Collins, CO 80522 SHOULD ANYOFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAIL30 DAYSWRITTEN NOTICETOTHE CERTIFICATE HOLDER NAMED TO THE LEFT, BUTFAILURE TODOSOSHALL IMPOSE NOOBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVE ,v ..v Luarl7 OT 2 01111 Z9 LLO © AGURO GORPURATION 19M IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ia�.vnv�ratiiaiJ2 Ot 2 4M237929 1CGeneral Liability p-tu�tB Who Is An Insured Policy Number: NHN211682 Policy Period: 04/27/04 to 04/27/05 Employees your employees, us insureds, with respect to such damages caused by cardio- (continued) pulmonary resuscitation or first aid services administered by such employee. H. property damage to any property owned, occupied or used by you or by any of your directors, managers, members, officers or partners (whether or not an employee) or by any of your employees. This limitation does not apply to property damage to premises while rented to you or temporarily occupied by you with pertnission of the owner. Volunteers Persons who are volunteer workers for you are lrua reds but they are insureds only for acts within the scope of their activities for you and at your direction. Real Estate Managers Persons (other than your employees) or organizations acting as your real estate managers are Insureds; but they are insureds only with respect to their duties as your real estate managers. Permissive Users Of With respect to mobile equipment registered in your name under a motor vehicle registration law: Mobile Equipment A. persons driving such equipment on a public road with your permission are btsuredc and B. persons or organizations responsible for the conduct of such persons described in subparagraph A. above are iaeareds; but they are insureds only with respect to the operation of the equipment and only if no other insurance of any kind is available to them. However, no person or organization is an insured with respect to: • bodily Injury to any co -employee of the person driving the equipment; or • property damage to any property owned or occupied by or loaned or rented to you, or in your charge or the charge of the employer of any person who is an insured under this provision. ,-i Vendors Persons or organizations who are vendors of your products are imuredr, but they are insureds only with respect to their liability for damages for bodily Injury or property damage resulting from the distribution or sale of your products in the regular course of their business and only if this insurance applies to the productr-completed operations ward. However, no such person or organization is an insured with respect to any: • assumption of liabi6ry by them in a contract or agreement. This limitation does not apply to the liability for damages for bodily injury or property damage that such vendor would have in the absence of such contract or agreement; • representation or warranty unauthorized by you; • physical or chemical change in your products made intentionally by the vendor; • repackaging, unless unpacked solely for the purpose of inspection, demonstration or testing, or the substitution of parts under instruction from the manufacturer and then repacked in the original container, Lieblpty Jnswaacs Form 77-e2-30W (Rev. 4-01) Commd Pegs 7 of W Who rs An Insured Vendors failure to make such inspections, adjustincats, lost,; or servicing as the vendor has agreed to (continued) make or normally undertakes to make in the usual course of business in connection with the distribution or sale of your products; demonstration, installation, servicing or repair operations, except such operations performed at the vptdor s premises in connection with the sale of your products; or of your products which, after distribution or sale by you, have been labeled or relabeled or used as a conlainer, ingredient or pan of any other thing or substance by or for the vendor. Further, no person or organization from whom you have acquired your products, or any container, ingredient or pan entering into, accompanying or containing your products, is an insured under this provision. ,,.4' Lessors Of Equipment Persons or organizations from whom you lease equipment are insureds; but they are insureds only with respect to the maintenance or use by you of such equipment and only if you are contractually obligated to provide them with such insurance as is afforded by this contract. However, no such person or organization is an insured with respect to any: damages arising out of their sole negligence, or occurrence that occurs, or offense that is committed, after the equipment lease ends. -,:„essors p;O1 £s.. ,2. .:nS eLa. .r,,: LOf Premises Persons or organizations from whom you lease premises arc insureds; but they are insureds only with respect to the ownership, maintenance or use of that particular part of such premises leased to you and only if you are contractually obligated to provide them with such insurance as is afforded by this contract. However, no such person or organization is an insured with respect to any: damages arising out of their sole negligence; occurrence that occurs, or offense that is committed, after you cease to be a tenant in the premises; or structural alteration, new construction or demolition operations performed by or on behalf of them. nY Subsidiary Or Newly K there is no other insurance available, the following organizations will qualify as named In oreds: Acquired Or Formed a subsidiary organization of the first named insured shown in the Declarations of which, at Organizations the beginning of the Policy period and at the time of loss, such first named lnamtYd controls, either directly or indirectly, iron than fifty (50) percent of the interests entitled to vote generally in the election of the governing body of such organization; or a subsidiary organization of the first named insured shown in the Declarations that such first owned irwred acquires or forms during the policy period, if at the time of loss such first named insured controls, either directly or indirectly, more than fifty (50) percent of the interests entitled to vote generally in the election of the governing body of such organization. N.'„Y.. �iF"RY 1 t MMIty bmranca Form Y7-02 3W (Rav4-01) contract Page 0 Of 32 Cliant#- 4RR97 r4 r7 TIM! ril l a ORQ CERTIFICATE OF LIABILITY INSURANCE 04/29/0°"Y) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Armstrong/Robitaille Bus&lnsSv ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 680 Langsdorf Drive #100 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO Box 34009 Fullerton, CA 92834-9409 INSURERS AFFORDING COVERAGE INSURED INSURER A: Federal Ins. Co/Chubb Econolite Control Products, Inc. — -- - -- - - - California Chassis, Inc INSURER B: - — — -- 3360 E. La Palma Avenue INSURER C: — - — -- Anaheim, CA 92806 INSURER D: ----- INSURER E: :OV 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF IN POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR DATE MM/DD/YY DATE MMIDD/YY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILRY r- -- CLAIMS MADE [XI OCCUR 35818716 04/27/04 04/27/05 EACH OCCURRENCE FIRE DAMAGE (Any one fire) MED EXP (Any one person) - $1 000 000 $1,000 000 $10,000 $1 �000,000 __ _ — jPERSONAL & ADV INJURY $21000,000 GEN'L AGGREGATE LIM ITAPPLIES PER: GENERAL AGGREGATE PRODUCTS COMP/OP AGG $1,000,000 71 POLICY X jEo- X LOC -- A i AUTOMOBILE li X LIABILITY ANY AUTO 73215072 04/27/04 04/27/05 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X HIRED AUTOS NON-OWNEDAUTOS BODILY INJURY (Per accident) $ : X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC ANY AUTO $ AUTOONLY: AGG EXCESS LIABILITY OCCUR CLAIMS MADE EACH OCCURRENCE $ _ _ AGGREGATE _ $ DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY , WC STATU- OTH- STORY LIMA� ER �___. - E.L. EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYEEI $ E.L. DISEASE -POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE:City of Fort Collins video Project The City of Fort Collins, it's officers, agents and employees are named as Additional Insured, as respects to General Liability, as required by written contract per form 17023080-0401 attached. City of Fort Collins,CO Director of Purchasing & Risk Management P.O. Box 580 Fort Collins, CO 80522 SHOULD ANYOF THE ABOVE D ESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAIL30_-DAYSWRITTEN NOTICETOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT, BUTFAILURE TODOSOSHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURE R,ITS AGENTS OR REPRESENTATIVE ^"`"^" wv T••�•l T OT L ?FmzjfUZU LLO W AGURU GURPURATION 1908 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. .a�vnvcaa�rroi/L OL :� 41Y[237929 1C at-lutaB Who Is An Insured Employees (continued) Policy Number: NHN211682 Policy Period: 04/27/04 to 04/27/05 General Liability • ynur employees, as Insureds, with respect to such damages caused by cardio- pulmonary resuscitation or first aid services administered by such employee. B. property damage to any property owned, occupied or used by you or by any of your directors, managers, members, ollicers or partners (whether or not an employee) or by any of your employees. This limitation does not apply to property damage to premises while rented to you or temporarily occupied by you with permission of the owner. E 2 Volunteers Persons who arevolunteer workers for von are Insureds; but they are bnsareds only for acts within the scope of their activities for you and at your direction. ReaI Estate Managers Persons (other than your employees) or organizations acting >as your real estate managers are insureds; but they are imureds only with respect to their duties as your real estate managers. s.Ed„ ..._ .. _.. Permissive Users Of With respect to mobile equipment registered in your name under a motor vehicle registration law: Mobile Equipment A. persons driving such equipment on a public road with your permission are hwureds; and B. persons or organizations responsible for the conduct of such persons described in subparagraph A. above ate insureds; but they are insureds only with respect to the operation of the equipment and only if no other insurance of any kind is available to them However, no person or organization is an Insured with respect to: bodily Injury to any co -employee of the persttn driving the equipment; or property damage to any property owned or occupied by or loaned or rented to you, or in your charge or the charge of the employer of any person who is an insured under this provision. Vendors Persons or organizations who are vendors of your products are lasureds; but they are insureds only with respect to their liability for damages for bodily Injury or property damage resulting from the distribution or sale of your products in the regular course of their business and only if this Insurance applies to the products-campleW operations hazard. However, no such person or organization is an insured with respect to any: • assumption of liability by them in a contract or agreement. This limitation does not apply to the liability for damages for bodily injury or property damage that such vendor would have in the absence of such contract or agreement; • representation or warranty unauthorized by you; • physical or chemical change in your products made intentionally by the vendor; • repackaging, unless unpacked solely for the purpose of inspection, demonstration or testing, or the substitution of parts under instruction from the manufacturer and then repacked in the original container. Liebipeyrnst rune Form 17-02_•_3090 (Rev. 4.01) Contract Page I of 32 Who /s An Insured Vendors failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to (continued) make or normally undertakes to make in the usual averse of business in connection with the distribution or sale of your products; demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of your products; or of your produMs which, after distribution or sale by you, have been labeled or relabeled or used as a container, ingredient or pan of any other thing or substance by or for the vendor. Further, no person or organization from whom you have acquired your products, or any container, ingredient or pan entering into, accompanying or containing your products, is an insured under this provision. s, v .:..:. .: <.d ,.:':'ei.e r.,.O n4g. . tr:x ✓.;.. tY«;< :,.:.,.i+Y a .'.'-x° .o�.x., s+:: Y 'C '..: Lessors Of Equipment Persons or organizations from whom you lease equipment are insureds, but they are huureds only with respect to the maintenance or use by you of such equipment and only if you are contractually obligated to provide them with such insurance as is afforded by this contract. However, no such person or organization is an Insured with respect to any: damages arising out of their sole negligence; or occurrence that occurs, or offense that is committed. after the equipment lease ends_ Lessors Of Premises Persons or organizations from whom you lease premises are insoredr, but they are imureds only with respect to the ownership, maintenance or use of that particular part of such premises leased to you and only if you are contractually obligated to provide them with such insurance as is afforded by this contract. However, no such person or organization is an insured with respect to any; damages arising out of their sole negligence; occurrence that occurs, or offense that is committed, after you cease to be a tenant in the premises; or structural alteration, new construction or demolition operations perforated by or on behalf of them. :; Subsidiary Or Newly If there is no other insurance available, the following organizations will qualify as namednwrds; nre Acquired Or Formed a subsidiary organization of the first named insured shown in the Declarations of which, at Organizations the beginning of the policy period and at the time of loss, such first named Inured controls, either directly or indirectly, more than fifty (50) percent of the interests entitled to vote generally in the election of the governing body of such organization; or • a subsidiary organization of the first named insured shown in the Declarations that such first named htwrad acquires or forms during the policy period, if at the time of loss such first named insured controls, either directly or indirectly, more than fifty (50) percent of the interests entitled 10 vote generally in the election of the governing body of such organization. r; a:;W:z LIaM I Insurance Farm 'r7-02.3=(Rev. 4-01) can"d Payer 8 of 32