HomeMy WebLinkAboutCHOICE CITY ELECTRIC DBA ENVIRONMENTAL SYSTEMS - INSURANCE CERTIFICATEgCOR� CERTIFICATE OF LIABILITY INSURANCE OP ID DA
DATE(MMIDDYYYY)
03/11 11
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 endomement(s).
PRODUCER -
Brown S- .Brown Inc
125 S Howes, 5th ,Floor
NAME: -
AIC No,Ext):
P O Box 2226
Fort Collins CO 80522-2226
_ADDRESS:
CUSTOMER _
CUSTOMER 10 tl: CHDICII
INSURER(S) AFFORDING COVERAGE
NAICY
Phone:970-482-7747 Fax:970-484-4165
INSURED
INSURERA: Westfield Insurance company
24112
Choice Cityy Electric
Environmental Systems Inc dba
INSURERB: Pinnacol Assurance Company
41190
INSURERC:
Environmental Systes Inc dba
132 ColDmerce Dr1Ve $1
Fort Collins CO 80524
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.
LTR
TYPE OF INSURANCE
NSR
WV�i
POLICY NUMBER
IMMIDD/YYYY)
T POLICY
(MM/ Df/YYY)
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE 1 7X OCCUR
-
CWP5852599
03/12/11
03/12/12
-
EACH OCCURRENCE
-DAMAGE TO R
PREMSES(Eaoconence
$1,000,000
s300,000
MED UP (My one person)
$ 10,000
PERSONAL 8 ADV INJURY
$1,000,000
-•
GENERALAGGREGATE
$2,000,000
GENL AGGREGATE LIMIT APPLIES PER:
POLICY PECOT LOG
PRODUCTS - COMPIOP AGG
$2,000,000
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
CWP5852599
03/12/11
03/12/12
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
X
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
A
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
CWP5852599
03/12/11
03/12/12
EACHGROCCURRENCE
$2,000,000
AGEGATE
$ 2, 000, 000
_
X I
DEDUCTIBLE
RETENTION $ 10000
$
S
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORJPARTNERIEXECUTIVF
OFFICERIMEMBER EXCLUDED? Y
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONSbelow
N I A
41 To490
04/01/11
04/01/12
X W TATU- 'O� -
TORV LIMITS ER
E.L. EACH ACCIDENT
$SOS, OOO
E.L. DISEASE- EA EMPLOYEE$
500, 000
E.L. DISEASE - POLICY LIMIT
I $500 000
A
(Leased/Rented Eq
CWP5852599
I03/12/11
03/12/12
Lsd/Rntd $50,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more space is required)
CERTIFICATE HOLDER CANCELLATION
City of Fort Collins
300 LaPorte Ave
CITYFCB I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
ACORD CORPORATI". All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD