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Home My WebLink AboutSOUTHLAND INDUSTRIES - INSURANCE CERTIFICATEACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE 03/30/OS 0/05IYYYY) PRODUCER 1-630-773-3800 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Arthur J. Gallagher & Co. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Two Pierce Place ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# Itasca IL 60143-3141 Attn: Sheryl Haas INSURED Southland Industries INSURER A: National union Fire Insurance Co. INSURERB:Old Republic Insurance Co. 17941 Fitch INSURER C: INSURER D: Irvine, CA 92614 INSURER E: COVERAGES 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 0U)DpL OF INSURANCE POUCYNUMBER POLICYEFFECTNE POLICY EXPIRATIONTYPE LIMITS 8 GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE IKI OCCUR X Contractual Liability MWZY56777 04/01/05 04/01/06 EACH OCCURRENCE $1,000,000 DAMAGE TO PREMISES RENTED $ 100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO- LOC CT PRODUCTS -COMP/OPAGG $2,000,000 B AUTOMOBILE LIABILITY ANYAUTO ALL OWNEDAUTOS SCHEDULED AUTOS HIREDAUTOS NON-OWNEDAUTOS MWTB19186 04/01/05 04/01/06 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Peraccident) $ X PROPERTYDAMAGE (Peraccident) $ GARAGE LIABILITY ANYAUTO AUTO ONLY -EA ACCIDENT $ OTHERTHAN EAACC AUTOONLY: AGG $ $ A EXCESSfUMBRELLALIABILITY X I OCCUR CLAIMS MADE FDEDUCTIBLE X RETENTION $ 10,000 BE2685631 04/01/05 04/01/06 EACH OCCURRENCE $25,000,000 AGGREGATE $25, 000, 000 $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEX INCL OFFICERIMEMBER EXCLUDED? EXCL If yes, describe under SPECIAL PROVISIONS below NKC11123900 04/01/05 04/01/06 X I WCSTATURY - I OR E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -FA EMPLOYEE $1,000,000 E.L. DISEASE -POLICY LIMIT 1 $1,000,000 B OTHER Auto Physical Damage MWZB19186 04/01/05 04/01/06 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Fort Collins DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 281 North College Avenue IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, IT$ AGENTS OR P.O. Box 580 REPRESENTATIVES. Fort Collins, CO 80522-0580 AUTHORIZED REPRESENTATNE USA ACORD 25 (2001/08) gerena ©ACORD CORPORATION 1988 lzovaua Powered Byl nrliflralecNnwTM 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. ACUKU 25 (2UU7/US) 'ACORD,� CERTIFICATE OF LIABILITY INSURANCE DATE /DD/YYYY) 03/30/OS PRODUCER 1-630-773-3800 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Arthur J. Gallagher & Co. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Two Pierce Place ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # Itasca , IL 60143-3141 Attn: Sheryl Haas INSURED Southland Industries INSURER A: National union Fire Insurance Co. INSURERB:Old Republic Insurance Co. 17941 Fitch INSURER C: INSURER D: Irvine, CA 92614 INSURER E: COVERAGES 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. DD' OF INSURANCE POLICY NUMBER POLICYEFFECTIVE POLICY EXPIRATIONE LIMITS rB GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE � OCCUR X Contractual Liability MWZY56777 04/01/05 04/01/06 EACHOCCURRENCE $1,000,000 PREMISES Ea occu $100,000 MEDEXP(Anyoneperson) $5,000 PERSONAL&ADVINJURY $1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO- LOC EC PRODUCTS-COMPJOPAGG $2,000,000 B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON -OWNED AUTOS MNTB19186 04/01/05 04/01/06 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTYDAMAGE (Peraccident) $ GARAGE LIABILITY ANYAUTO AUTO ONLY -EA ACCIDENT $ OTHERTHAN EAACC AUTOONLY: AGG $ $ A EXCES91UMBRELLA LIABILITY X OCCUR CLAIMS MADE RXDEDUCTIBLE RETENTION $ 10,000 BE2685631 04/01/05 04/01/06 EACH OCCURRENCE $25, 000, 000 AGGREGATE $25, 000,000 $ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEX INCL OFFICER/MEMBER EXCLUDED? EXCL Ayes, describe under SPECIAL PROVISIONS below NKC11123900 04/01/05 04/01/06 X WCSTATU- LtMIB E.L. EACH ACCIDENT $1,000,000 — E.L. DISEASE -EA EMPLOYEE $1,000,000 E.L. DISEASE -POLICY LIMIT $1,000,000 B OTHER Auto Physical Damage MWTB19186 04/01/05 04/01/06 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS THE CITY OF FORT COLLINS IS INCLUDED AS AN ADDITIONAL INSURED PER THE TERMS AND CONDITIONS OF THE CONTRACT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITY OF FORT COLLINS DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 281 NORTH COLLEGE AVE IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR PO BOX 580 REPRESENTATIVES. I FORT COLLINS, CO 80522-0580 AUTHORIZED REPRESENTATIVE USA ( s ACORD 25 (2001/08) gerena ©ACORD CORPORATION 198E aao:euA Powered BYCnr/ifirolceM, ,,Ta 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. ACORD 25 (2001108)