HomeMy WebLinkAboutINTEGRATED FABRICATION - INSURANCE CERTIFICATEINSURANCE ADVISORS INC Fax:9525930903 Apr 13 2004 14:40 P.01
MORA CERTIFICATE OF LIABILITY INSURANCE _PI 3
Boa 3D o'
IRODUCER
[nsuranCe Advisors, Inc.
L5020 21th Avenue N.
?lymouth NCI 55447
Phone:763-536-8006 Fax:763-398-4060
THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC9
NSURED
Integrated Fabri tion LLC
5350 Highway 61 5 55110
White Bear La
INSURER& Allied Insurance
19100
INSURER B:
INSURER C
INSURER0:
INSURER E'
�OVERAGFS
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VNICH 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.
-TR
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE M
DATE MMNOIYY
LIMITS
A
X
GENERALLwBILITY
X COMMERCIALGENERALLIABILITY
CLAIMS MADE aOCCUR
ACP7101527089
03/31/04
03/31/05
EACHOCOURRENCE
$2,000,000
PREMISES Ego ,nte
$200,000
MIND EXP(Any enspb*W)
$10,000
PERSONAL d ADV INJURY
S2 00O 000
GENERAL AGGREGATE
S 4 000 000
GEHL AGGREGATE LIMIT APPLIES PER'
P LOC
POLICY 7
PRODUCTS-COMPlOP AGO
$4,000 000
AUTOMOBILE
UAEILIT/
ANY AUTO
ALL OW NgD AUTOS
SCHEDULEDAUTOS
HIRED AUTOS-
NON -OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea WoMrst)
$
BODILY INJURY
(Per Peram)
$
BOpILV INJURY
(Per *=WS M)
$
PROPERTY DAMAGE
(PPr accident)
S
GARAGE LIABILITY
ANY AUTO
AUTO ONLY -EAACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGO
$
$
A
EXCESSIUMBRELLA LIABILITY
OCCUR F7CLAIMS MADE
DEDUCTIBLE
X RETENTION $10,000
PENDING
03/32/04
03/31/05
EACH OCCURRENCE
$ 1, 000 , 000
AGGREGATE
$ 1 000 000
$
$
s
WORKERS COMPENSATION AND
EMPLOYERS' LIABIUTY
ANY PROPRIETOR(PARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUOE07
If yes, describe under
SPECIAL PROVISIONS 09I9w
T RV LIMBS ERr
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
ILL, DISEASE -POLICY LIMIT
$
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES! EXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS
The certificate holder is listed as an additional insured.
CERTIFICATE HOLDER CANCELLATION
FORTCOL
City Of Fort Collins
Attn : Ron KEChbar
Fax; 97 0-221- 67 0 7
215 N. Mason St.
Fort Collins MN 80522
SHOULD ANY OF THE ABOVE DE50RIEED POLICIES BE CANCELLED BEFORE THE EXPIRA
DAYS THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED YO THE LEFT, BUT FAILURE TO 00 SO SKA
IMPQFR Na OBLIGATION OR UA6MTY OF ANY KIND UPON THE INSURER. ITS AGENTS OR
REPREEENTnTIVE$
AUTHORRED REPRESENTATIVE
Michael T,LaFond
f+wrlu co 14VOTJue) W ACORD CORPORATION 17