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Home My WebLink AboutSTURGEON ELECTRIC - INSURANCE CERTIFICATE (3)ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (M.1 YYYY) ,a 03/Ol/05 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 Two Pierce place HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Itasca, IL 60143 Michele Moore 630-285-3931 INSURERS AFFORDING COVERAGE NAIC# INSURED Sturgeon Electric Company, Inc. INSURERA:Athena Assur Cc (A XV) 41769 INSURERB:Zurich American Ina Cc (A XV) 16535 12150 E. 112th Avenue INSURERC: INSURERD: Henderson, CO 80640 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 ADDI POLICY NUMBER POLICY EFFECTIVE IMM LICY EXPIRATION PODATE LIMITS H GENERAL LIABILITY GLOS37415410 09/30/04 09/30/05 EACHOCCURRENCE $2,000,000 X COMMERr,IAL GENERAL LIABILITY CLAIMSMADE FXIOCCUR DAMAGE TED PREMISES Ea occw once � $ 100, 000 MED EXP(Any one person) $5,000 PERSONAL B ADV INJURY $2,000,000 T-1 GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $4,000,000 JECT X POLICY PRO- LOC B H AUTOMOBILE LIABILITY ANYAUTO BAPS3741SSOB (A/O/S) TAP837415608 (TX) 09/30/04 09/30/04 09/30/05 09/30/05 COMBINED SINGLE LIMIT (Ea accident) $2,000,000 X BODILY INJURY (Perperson) $ ALL OWNED AUTOS SCHEDULEDAUTOS BODILY INJURY (Peraccident) $ HIREDAUTOS NON-OWNEDAUTOS X PD Comp Ded $100,000 PROPERTYDAMAGE (Per accident) $ X PD Coll Ded $100,000 AUTO ONLY -EA ACCIDENT $ANYAUTO OTHER THAN EAACC $ 1GARAGELIABILITY $ AUTO ONLY: AGG A EXCESSIUMBRELLA LIABILITY X OCCUR CLAIMS MADE QK06800832 09/30/04 09/30/05 EACHOCCURRENCE $10, 000, 000 AGGREGATE $ 10, 000, 000 $ DEDUCTIBLE X RETENTION $ 10,000 $ H S H WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PAR-iNER/EXECU7IVE INC OFFICER/MEMBER EXCLUDED? EXCLWC837415308 Use describe under SPECIAL PROVISIONS below WC837415208 (A/O/S) NC837415108 (CA) (wI/OR) 09/30/04 o 0_/30/04 09/30/04 09/30/05 09/30/OS 09/30/05 TH- X 7R STATU- OER- T IT E.L. EACH ACCiDEh1T $L, 000, 000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE -POLICY LIMIT $1, 000,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Description of Job: SECO Job No. 821536 - Replace 8e & 12e LED's from Traffic Signal heads at various locations determined by the City of Fort Collins Traffic Operations Department City of Fort Collins, Colorado is shown as an additional insured solely with respect to general liability and automobile liability coverage as evidenced herein as required by written contract with respect to work performed by the named insured. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 1556 DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN City of Fort Collins, Colorado NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL John Stephen P.O. Box 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR P.O. REPRESENTATIVES. Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE /, );'1 USA �/1/`a.4TIJJ/ ACORD 25 (2001/08) michelel © ACORD CORPORATION 1988 Powered BYCertificatesNowrN 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.