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HomeMy WebLinkAboutTEPA EC LLC - INSURANCE CERTIFICATEACORD„, CERTIFICATE OF LIABILITY INSURANCE DATE12/28DD/Y/zo08z/za PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Wells Fargo Ins Services Mountain West ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 5755 Mark Dabling Boulevard Suite 300 HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Colorado Springs CO 80919-2228 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (719) 592-1177 (719) 592-0799 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURCRA Travelers Property Casualty Co 25674 TEPA EC. LLC ___ .._.... ..._. INSURERS: Pinnacol Assurance 4119090 5045 List Drive Colorado Springs CO 80919 COVERAGES C. 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 I DULII - -- POLICY EFFECTIVE POLICY EXPIRATION - - - _-- LTR N RDINSURANCE I POLICY NUMBER DATE MWDD1Y)O DATE MMIDD1YY1 LIMITS GENERAL LIABILITY EACH OCCURRENCE- S 1_1_000, 000 A X ( COMMF.RCIAI GENERAL LIABIL II Y CO0243B547IND09 1 1 2009 / / 1 1 2010 / / DAMAGE TO HEN FED PREMISE-S Fa occurence) $ 300, 000 _ - I I CLAIMS MADh I X I OCCUR MED EXP(A, u,e pen.,) _ G 5,000 X Blanket AI/WOS PERSONAL&ADV INJURY $ 1, 000, 000 _._._. GENERAL AGGREGATE $ 2,000,000 GENT. AGGRECArE II MIT APPLIES PER: PRODUCTS - COMPIOP AGO_ $ 2,000,000 1 PlFr'TRO- ( POLICY X I LOC nn to eeneE.. cs p yee 1,000, 000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMA A X ANY nUTo C002938597IND09 1/1/2009 1/1/2010 (Fa aCUftln 1,000,000 — At L OWNED$ AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) g TIRED AUTOS BODILY INJURY $ I NON OWNED AMOS (Per acatlen0 _ X Hired Physical Dmge j -- -- PROPERTY DAMAGE (Per accidenO $ ( X $500 Comp/$500 Coll 1,000 GARAGE LIABILITY AU IO ONI Y - EA ACCIDLN I' $ -� ANY ALI0 OI HER THAN CAACC $ _.. ..... AU IO ONLY: AGO I $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE 1 4,000,000 A X.j OCCUR CIAIMS MADE I 1110243B547TIL09 1/l/2009 1/l/2010 1 4,_000,000_ (AGGREGAIE 1 DEDUCTIBLE g X I RE H-NNON $ i0, 000 _ $ - B WORKERS COMPENSATION AND 4059519 1/l/2009 1/l/2010 OTII- X I EMPLOYERS' LIABILITY CRY 1012Y T,IMIT$ ER LIMID ANY PROPRIETOIitt'ARTNER/RXECUIIVE L [?CIa aCCIUFNI g 500, 000 OFFICER/MEMBER EXCLUDED' E.L. DISEASE EA EMPLOYED $ 500, 000 II yes, describeunder SPI-CIALPROVISIONS bcloV; -- -- E.L.DISEASE - POLICY LIMIT -- S 500,000 C jOTHER Workers Compensation WC47714826840 1/l/2009 1/1/2010 Other States j Limits: $500k/$500k/$500k A Inland Marine 6600536H01808 1/1/2009 1/1/2010 Leased/Rented Equip: $150,000 Installation: $250,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS UAINt,t LLA I TUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Ft Collins DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 11310, - DAYS WRITTEN -- NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 50 SHALL PO Box 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Ft Collins CO 80522 AUTHORIZED REPRESENTATIVE AULJKU Lb (ZUUI/Ue) © ACORD CORPORATION 1988 12/28/2008 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. MIi Ku LD tLvv uvo)