HomeMy WebLinkAboutSIMPSON ELECTRIC INC - INSURANCE CERTIFICATE (2)AGJRda CERTIFICATE OF LIABILITY INSURANCE DATE03/03/2008)
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PRODUCER (303) 776-5122 FAX (303) 776-S49S THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
First MainStreet Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
S12 4th Avenue HOLDER THIS CERTIFICATE DOES NOT AMEND EXTEND OR
P 0 Box 847 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
Longmont, CO 80502 INSURERS AFFORDING COVERAGE NAIC #
INSURED Simpson Electric, Inc INSURERA Charter Oak Fire Insurance Co 2561S
DBA Simpson Electric of Colorado INSURERB Progressive Financial Casualty 11770
1920 Glenview Court INSURERC Pinnacol Assurance
Berthoud CO 80513 NSURERO
INSURER 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
DD'
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
02/20/2008
POLICY EXPIRATIONDAM fmwnDry,,i
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE IA OCCUR
6803299C3 S9
02/20/2009
EACH OCCURRENCE
$ 1 QQQ r QQ
DAMAGE TO RENTED
$ 300,00
$ S.000
MED EXP (Any one person)
PERSONAL & ADV INJURY
$ 1,000QQ
GENERAL AGGREGATE
$ 2,000,000
GEN L AGGREGATE LIMIT APPLIES PER
17 POLICY JEST LOC
PRODUCTS COMP/OPAGG
IS2,000.00
AUTO
MOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
5536212-1
11/24/2007
11/24/2008
COMBINED SINGLE LIMIT
(Ea accident)
S 1,000,000
B
SCHEDULED AUTOS
HIRED AUTOS
BODILY INJURY
(Per person)
X
X
NON OWNED AUTOS
BODILY INJURY
(Par accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTOONLY EAACCIDENT
$
ANY AUTO
OTHER THAN EA ACC
$
AUTO ONLY AGO
$
EXCESS/UMBRELLA LIABILITY
OCCUR CLAIMS MADE
$
$
DEDUCTIBLE
;24
RETENTION $
$WORKERS
COMPENSATION AND
EMPLOYERS LIABILITY1495820
EANY XCLUDD� ECUTIVE
1495820
04/01/2009
04/01/2007
04/01/2009
/01/2008
04COFFICERIMEMER
$ 1, QQQ OQQIf
E L DISEASE EA EMPL
1.000. 00
yes describe under
SPECIAL PROVISIONS below
OTHER
E L DISEASE POLICY LIMIT I $1,000,00
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS
City of Fort Collins
P 0 Box 580
Fort Collins CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVFR
ACORD 25 (2001/081 FAX (970)224-6134
vn�.VnV VVmru"1 fVIN TBBB
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
ernen ne 1,.....,