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HomeMy WebLinkAboutSIMPSON ELECTRIC INC - INSURANCE CERTIFICATE (3)AC RD,, CERTIFICATE OF - LIABILITY INSURANCE DATE(MMIDD/ Y PRODUCER (303) 776-5122 FAX (303) 776-5495 First MainStreet Insurance 512 4th Avenue P.O. Box 847 02/12/2009 9 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Longmont, CO 80502 INSURERS AFFORDING COVERAGE NAIC # INSURED Simpson Electric, InC. DBA: Simpson Electric of Colorado 1920 Glenview Court Berthoud, CO 80513 INSURERA: Travelers Indemnity Co. of CT 25682 INSURER Progressive Financial Casualty 11770 INSURER : Pinnacol Assurance INSURERD: 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 DATE iMMjDQfYYj POLICY EXPIRATION LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR 6803299C359 02/20/2009 DATE fMMjnOtYYj 02/20/2010 EACH OCCURRENCE $ 1,000, 000 DAMAGE TORENTED PREMISES (Ed occi Ears,,P) $ 300'QQQ MED EXP (Any one person) $ 5,0()( PERSONAL &ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,000.00( GEHL AGGREGATE LIMIT APPLIES PER: POLICY JECT LOC PRODUCTS - COMP/OPAGG $ 2,000,000 B AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 05536212-2 11/24/2008 11/24/2009 COMBINED SINGLE LIMIT (Ea accident) $ 1, QQQ' QQQ BODILY INJURY (Per person) $ X X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHERTHAN EAACC AUTO ONLY: AGG $ $ EXCESSIUMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER 1495820 04/01/2008 04/01/2009 X WC STATU- OTH- E.L. EACH ACCIDENT $ 1.000.000 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE - POLICY LIMIT $ 1,000.000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS City of Fort Collins P.O. 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 AGFNTR nR RERcacaurnnvro AUTHORIZED REPRESENTATIVE .-.....,... w%nvv uvv/ .,.,.. '..,..'....-.--" ©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 (2001/08)