HomeMy WebLinkAboutAMERICAN SPRINKLER - INSURANCE CERTIFICATE (2)ACORD- CERTIFICATE OF LIABILITY INSURANCE 0DATE (MM/D
2/04109DrYYYY)
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood &Peterson Ins. Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P. O. Box 578; ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
4687 W. 18th:Street...; •
Greeley; C0.,.80632 - INSURERS AFFORDING COVERAGE NAIC #
INSURED - INSURER A: Maxum Specialty Insurance Group - - -
American.Sprinkler Inc. INSURER B: Pinnacol Assurance
14583 N. Meadow Woods Street INSURER c: Travelers Insurance Company
Brighton, CO 80603 INSURER D:
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.
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MMIDD/YY
POLICY EXPIRATION
DATE MM/DD/YY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 51OCCUR
X BI/PD Ded:5,000
GLP600677602
02/01/09
02/01/10
EACH OCCURRENCE
$1000000
DAMAGE TO RENTEDPREMISES (E.
$50OOO
MED EXP (Any one person)
$5 000
PERSONAL & ADV INJURY
$1,000,000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY X PRO LOC
JECT
PRODUCTS - COMP/OP AGG
s2,000,000
C
AUTOMOBILE
LIABILITY
ANY AUTO
.. .. _.
ALL:OWNED AUTOS
SCHEDULED AUTOS
rHIRED AUTOS
NON -OWNED AUTOS
Drive Other Car
BA2707L99AO9SEL
02/01/09
02/01/10
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,OQO
X
BODILY INJURY
(Per person)
$
X
BODILY INJURY
(Per accident)
$
X
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
A
_
EXCESS/UMBRELLA LIABILITY
X I OCCUR CLAIMS MADE
DEDUCTIBLE
_ RETENTION $
EXC600895601
02/01/09
02/01/10
EACH OCCURRENCE
$1,000,000
AGGREGATE
$1 OOO 000
$
$
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
_
4111723
02/01/09
02/01/10
X WC STATUMIT- CER
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE - EA EMPLOYEE
$1,000,000
E.L. DISEASE - POLICY LIMIT
$1,000,000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
L,rK I IrN.A I t MULUCK L;ANGtLLA I IUN
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 _3n DAYS WRITTEN
300 La Porte Avenue
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Fort Collins, CO 80521
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2001108) 1 of 2 #M436298 BXD 0 ACORD CORPORATION 1988
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-S (2001/08) 2 of 2 #M436298