HomeMy WebLinkAboutPB AMERICAS INC. - INSURANCE CERTIFICATEACORDTM, CERTIFICATE OF LIABILITY INSURANCE 11/1/2010
DATE (MM/DD/YYYY)
10/27/2009
PRODUCER Lockton Companies, LLC-1 Kansas City
444 W. 47th Street, Suite 900
Kansas City MO 64112-1906
(816) 960-9000
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.
INSURERS AFFORDING COVERAGE
NAIC #
INSURED PB AMERICAS, INC.
1319027 ONE PENN PLAZA
NEW YORK NY 10119
INSURER A: American Casualty Company of Reading, PA
20427
INSURER B: Continental Casualty Company
20443
INSURER C :
INSURER D :
INSURER E
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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
ADD'L
POLICY EFFECTIVE
POLICY EXPIRATION
LTR
INSRD
TYPE OF INSURANCE
POLICY NUMBER
DATE (MM/DD/YY)
DATE (MM/DD/YY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 2,000,000
DAMAGE TO RENTED
PREMISES Ea occurence
$ 300,000
B
X COMMERCIAL GENERAL LIABILITY
GL 2098341226
1 I/1/2009
11/1/2010
CLAIMS MADE FRI OCCUR
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 2,000,000
GENERAL AGGREGATE
$ 5,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 5,000,000
PRO -
POLICY JECT LOC
B
AUTOMOBILE LIABILITY
BUA 2098341243
11/1/2009
11/1/2010
COMBINED SINGLE LIMIT
$ 2,000,000
X ANY AUTO
(Ea accident)
BODILY INJURY
$ XXXXXXX
ALL OWNED AUTOS
SCHEDULED AUTOS
(Per person)
BODILY INJURY
$ XXXXXXX
HIRED AUTOS
NON -OWNED AUTOS
(Per accident)
PROPERTY DAMAGE
$ XXXXXXX
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$ XXXXXXX
ANY AUTO
NOT APPLICABLE
OTHER THAN EA ACC
$ XXXXXXX
AUTO ONLY: AGG
$ XXXXXXX
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$ XXXXXXX
OCCUR ❑ CLAIMS MADE
AGGREGATE
$ XXXxxxX
$ XXXXXXX
NOT APPLICABLE
UMBRELLA
$ XXXXXXX
DEDUCTIBLE FORM
$ XXXXXXX
RETENTION $
A
WORKERS COMPENSATION AND
WC 298341 176 (AOS)
1 i/i /2009
i 1/1/2010
X WC STATU- OTH-
TDRY LIMITS ER
EMPLOYERS' LIABILITY Y / N
E.L. EACH ACCIDENT
$ 1,000,000
A
ANY PROPRIETOR/PARTNER/EXECUTIVE
1
WC 2983411.93 (CA ONLY)
I I/1/2009
11/1/2010
B
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
WC 298341209 OR ONLY)
I I/1/2009
11/1/2010
E.L. DISEASE - EA EMPLOYEE 1
$ 11000,000
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT 1
$ 1,000,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
(PB #A) CITY FORT COLLINS MIST - CITY OF FORT COLLINS, ITS OFFICERS, AGENTS AND EMPLOYEES ARE ADDITIONAL INSUREDS AS
RESPECTS GENERAL AND AUTO LIABILITY AS PERTAINING TO PB AMERICAS, INC. OPERATIONS, WHERE REQUIRED BY WRITTEN
CONTRACT.
1
CITY OF FORT COLLINS
RISK MANAGEMENT
PO 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 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
ACORD 25 (2009/01)
988-2009 SCC@tD CORPORATION. All rights reserved
The ACORD name and logo are registered marks of ACORD
For auestions reaardino this certificate, contact the number listed in the 'Producer' section above and soecifv the client code'PARBR02'.