HomeMy WebLinkAboutT AND R ELECTRIC SUPPLY - INSURANCE CERTIFICATEACOR4,, CERTIFICATE OF LIABILITY INSURANCE 0/10 M,D°'"
10/10/OB
PRODUCER 1-605-336-1090 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Holmes Murphy & Assoc -SF ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
600 South Cliff Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 108 —
Sioux Falls, SO 57104-5320 INSURERS AFFORDING COVERAGE
INSURED INSURED A C N A INSURANCE
T & R ELECTRIC SUPPLY CO INC - - - -- -
PO BOX 180
COLMAN, SD 57017
COVERAGES
INSURER
INDEMNITY COMPANY
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.
LTR INSR - TYPE OF INSURANCE POLICY NUMBER - POLICY EFFECTIVE POLICY EXPIRATION - - -
DATE IMMIDDIYYI DATE Myy LIMITS
A
GENERAL LIABILITY
C299307463
04/30/08
04/30/09IEACH OCCURRENCE $ 1,000, 000
COMMERCIAL GENERAL LIABILITY
HIRE DAMAGC (Any onetre) 5200, 000
CLAIMS MADE [XI
OCCUR
MED EXP Any one person) 515, 000
_—
,___-___.___(PERSONAL&ACV
INJURY IS 1, 000,000
GENERAL AGGREGATE S2, 000, 000
SENT AGGREGATE LIMIT APPLIES PER
PRODUCTS COMP/DP AGG $2,000,_000
-1-_.-
._PRO-
POLICY LOC
IFCT
A
AUTOMOBILE
LIABILITY
C9000063177
04/30/08
04/30/09
COMBINED SINGLE LIMIT g 1, 000, 000
X
ANY AUTO
(Ea accitlenl)
ALL OWNED AUTOS
BODILY I
SCHEDULED AUl'OS
(Per person) $
X
-
HIRED AUTOS
i
;BODILY INJURY
X
_
NONOWNED AUTOS
(Per accident) I $
---- ----
PROPERTY DAMAGE S
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
ANY AUTO
BOTHER THANEA ACC $
j AUTO ONLY AGG $
B
LIABILITYr
NHN039573
04/30/08
04/30/09 EACH OCCURRENCE 20, 000, 000
_EXCESS
I
X� OCCUR -__J CLAIMS MADE
AGGREGATE _. 520, 000,000
DEDUCTIBLE
S
X RETENTION $10, 000
$
A
WORKERS COMPENSATION AND
WC500063182
04/30/08
04/30/09 g WC $TATU- OTH
IorRY LIMB$--"
EMPLOYERS' LIABILITY
_ _
E.L. EACH ACCIDENT � $ 500, 000
E.L. DISEASE - EA EMPLOYEE( S 500,000
E.L. DISEASE POLICY LIMIT I $ 1, 000, 000
OTHER
S
S
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Certificate Holder is included as an Additional Insured as respects General Liability coverage.
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 20 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Purchasing Division PO Box 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES. qqq
Fort Collins, CO 85022 AUTHORIZED REPRESENTATIVE
USA
ACORD 25-S (7/97) ktuschensf 0 ACORD CORPORATION 10AA
1UU I5481
Certificate Delivery by CertificatesNow - www.ConfinniNel.cont - 877,669,8600
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.
25-S