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HomeMy WebLinkAbout263373 ELECTRONIC SYSTEMS INTERNATIONAL INC - INSURANCE CERTIFICATE (2)From:Suzanne Storm FaxID:719-590-9992 Page 1 of 1 Date:12/30/2010 01:24 PM Page:1 of 1 OP ID: SG A�ORO' CERTIFICATE OF LIABILITY INSURANCE DAT12/30DNYVY) 12I30/10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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 endorsements . 719-590-9990 Six 8r Geving Insurance, Inc. 719-590-9992 CONTAPRODUCER NAME: Suzanne Storm ACNE. Ext:719-8674502 AIc, No): 719-590-9992 3630 Sinton Road, Suite 200 Colorado Springs, CO 80907-5034 Randy Geving E-MAIL ADDRESS: sstorm@six-geving.com PRODUCER ELECT-1 CUSTOMERID#: INSURER(S) AFFORDING COVERAGE NAIC S INSURED Electronic Systems INSURER A: First Mercury Insurance Co International, Inc. INSURERB: Pinnacol Assurance 41190 3010 Mallard Drive INSURER C:Acuity 14184 Colorado Springs, CO 80910-2247 INSURER D INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSR D POLICY NUMBER POLICY EFF MMIDDNYYY POLICY EXP MM/DDNYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 P REMISES Ee occurrence $ 50,000 A X MERCIAL GENERAL LIABILITY COM PENDING 01/01/11 01/01/12 CLAIMS -MADE OX OCCUR MED EXP(Any one person) $ 5,000 PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PROJECT 7 LOC $ C AUTOMOBILE X LIABILITY ANY AUTO L75688 01/01/11 01/01/12 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Pet person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS H IRED AUTOS PROPERTY DAMAGE (Per accident) $ NON -OWNED AUTOS UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE AGGREGATE EXCESS LIAB DEDUCTIBLE $ - $ RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N I A 4076606 01/01/11 01/01/12 X. WC STAT U- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) P1-1will l IIII P7G11 IaGP1IR 11. CITYF-2 City of Ft. Collins Director of Purchasing and Risk Management P.O. Box 580 Ft. Collins, CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED /AQREPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD