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HomeMy WebLinkAboutEXCEL SHEET METAL EXCEL BRIDGE - INSURANCE CERTIFICATEACORQ,., CERTIFICATE OF LIABILITY INSURANCE 091108/2009 PRODUCER (714) 569-2700 FAX (714) 569-3099 Pridemark-Everest Insurance Services, Inc. A Leavitt GroupCo #OF13098 1820E. First Street, Ste 500 Santa Ana, CA 92705 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 Excel Sheet Metal Inc. DBA: Excel Bridge Manufacturing Co 12001 Shoemaker Avenue Santa Fe Springs, CA 90670 INSURER Employers Insurance Co of Waus 21458 INSURER B. INSURER C 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. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION MMIDDIYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE § COMMERCIAL GENERAL LIABILITY CLAIMS MADE ❑ OCCUR DAMAGE TO RENTED aacc rc �ra� S _ LED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS COMPIOPAGG $ POLICY PRO- - ECT OC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT Be acatlenp § ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) § HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accitlent) $ PROPERTY DAMAGE (Per accitlent) $ GARAGE LIABILITY AUTOONLY EAACCIDENT S ANY AUTO OTHERI'HAN EA ACC S $ AUTO ONLY-. AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑CLAIMS MADE AGGREGATE § 5 $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WCC-Z91-452479-019 08/01/2009 08/01/2010 X WC STATU- OTH (� EMPLOYERS' LIABILITY ANY PROPR IE, i'PARTNEREXECUI VE E I. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 OFFICER/MEMBER EXCLUDED? If yes describe under SPECIAL PROVISIONS below El DISEASE -POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS e: Pleasant Valley Trails "Except 10 days notice of cancellation due to non-payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL City of Fort Collins 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, P.O. Box 580 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 215 Madison St. OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE Gary Wells/SS ACORD 25 (2001/081 ©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)