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Home My WebLink About116519 MAXWELL PRODUCTS INC - INSURANCE CERTIFICATE (3)OP ID: CB a►14. z CERTIFICATE OF LIABILITY INSURANCE DATE /09/11VVY) 06/09/11 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 endorsement(s). - - PRODUCER ,, _, 801-924-1400 NA T CT The Presidio'Group, Inc.- ------__.. _ 801-924-1441 5295South 300 West -#550' ,per" ,:nr Salt Lake City, UT 84107 - Alan W. Lord CIC, CWCA1 - al° N ,ExO; •- - FAX No).-- E-MAIL - -: -' - ADDRESS: .. -• - .. _.-- -PRODUCER- MAXPRI - - — " ---'-- CUSTOMER ID9:- - '- INSURER(S) AFFORDING COVERAGE NAIC p _ _ INSURED Maxwell Products, Inc. INSURER A:Ironshore Insurance Ltd. 650 S Delong Street INSURER B: Colorado Casualty Insurance 141785 Salt Lake City, UT 84104 INSURER C: Employers Insurance Group 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 REOUIREMEN'I, '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 BYjjPAID CLAIMS. '- --- - --- -_--._ WSR IAODLr Vivo POLICY NUMBER I MDMIDDIYFVVV MMIDD//YYYY LIMITS LTR TYPE OF INSURANCE --- GENERAL LIABILITY •..".-. EACII OCCURRENCE ' $ 2,000,00 A 1 'X COMMERCIAL•GENERAL LIABILITY. { CLAIM'-MADE'EI OCCUR - - -C. -- .., ., 000228001 _ -- ... ___ _ 04/05/11 - -_. 04/05/12 - YAMAGET0 R2N1EO. PREMISES (ra occurrence)_ $ -"- 500,0000 MBDEXPiAnyonepa ma) I'$' - 25,00 PERSONAL 3 ADV INJURY I $ 2,000,00 GENERAL AGGRE.GAIF $ 4,000,00 GEN'1. AGGREGATE LIMI I APPLIES PER PRODUCI S-COMPIOPAGG 2,000,00 POLICY -II f,o I LOC Pollution _$ 5 2,000,0D B AUTOMOBILE LIABILITY ANYAUTO BA8683295 06/12/11 06/12/12 COMBINED SINGLE LIMI I (Ea lmckInp $ 1,000,00 BODILY INJURY (per person) $ ALL OWNED AUTOS SCHEDULED AUTOS AIRED nil ro5 BODILY INJURY(uer accident) $ — X PROPERTY Y DAMAGE (Perer accident) — $ X X NON-O)ANFD AUTOS $ $ _ - UMBRELLA LIAR iJCQ1R - EACH S — AGGREGATE EXCESS LIAB CI AIMS-MAnE DEDUCTIBLES _ RETENTION $ $ WORKE0.$COIdPENSATION y VJC SrAN- OTH- G ANDEMPLOYER S'LIABILITY V/N ANY PROPRIETORIPARTNERtEXECUIIVGr I OFFICERIMEMBEIi EXCLUDED9 IJ (Mandatory is NH) If yes. describe under N / A FN0329778-06 08/01/10 08/01/11 —10RYDNIII S,I_I ER_ E.L. EACH ACCIDENT Is 100,00 jj__ L.L. DISEASE- EA LMPLOYEEI S 100,00 F.LD16LASE-POLICY I IMITIS 500,06 DESCRIPTION OF OPERATIONS holow B Inland Marine I IM8696815 06/12/11 06/12/12 177,60 I (Equipment Ded 1,00 DESCRIPTION OF OPERATIONS l LOCATIONS l VEHICLES (Attach ACORD 101, Additional Remarks Schedule, Harder space is required) Subject to the terms and conditions of the Policy. City of Fort Collins is additional insured as respects general liability per form 94358 04107 attach JO : 6080 rack Seal Mathrial CITYFOR City of Fort Collins Purchasing Division PO Box 580 Fort Collins, CO 80522 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 REPRESENTATIVE v "ba-zuuy AUUKU UURHURATION. All rights reserved. ACORD 2512009109) The ACORD name and logo are registered marks of ACORD respects any physician, dentist, nurse, emergency medical technician or paramedic who is employed by you to provide such services, provided you are not engaged in the business of providing such services. (2) property damage or environmental damage to property: (a) Owned, occupied or used by, (b) Rented to, in the care, custody or control of, or over which physical control is being exercised for any purpose by you, any of your employees, volunteer workers, any partner or member (it you are a partnership or pint venture), or any member (if you are a limited liability company). b. Any person (other ttm your employee or volunteer worker) or any organization while acting as your real estate manager. c, Any person or organization having proper temporary custody of your property 9 you die, but only: (1) With respect to liability arising out of the maintenance or use of that property; and (2) Until your legal representative has been appointed. d. Your legal representative if you die, but only with respect to duties as such. That representative will have all your rights and duties under this Policy. e. Any subsidiary, associated, affiliated or allied company or corporation, including subsidiaries thereof, of which you have more than 50% ownership interest as of the inception date, of this Policy. _. - S My organization you newly acquire or form, other than a partnership, joint venture, or limited liability company, and over which you maintain ownership or majority interest, will qualify as a Named Insured if there is no other similar insurance available to that organization. However: a. Coverage under this provision is afforded only (a) until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier, (b) provided that you give us written notification within 180 days of the date of such acquisition or formation or before the end of the policy period, whichever is earlier, and (c) 0 an additional premium, calculated by the company using its reasonable underwriting discretion but not to exceed 100% of the policy premium at irnception, is paid when due; b. Coverage A and E do not apply to bodily Injury, property damage or environmental damage that occurred before you acquired or formed the organization; and c. Coverage B does not apply to personal and advartising Injury arising out of an offense committed before you acquired or formed the organization. 4. Except as respects to Coverage E-4, any person or organization with whom you agreed to include as an insured, because of a written contract, written agreement or permit, but only with respect to bodily injury, property damage, environmental damage or personal and advertising Injury caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf, arising out of your operations, your work, equipment or premises leased, rented or owned by you, or your products which are distributed or sold in the regular course of a vendor's business, however: As respects vendors, this Insurance does not apply to: a. Bodily Injury, property damage or environmental damage for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not 94358 (4/07) C13063 Page24 Of 44 apply to liability for damages that the vendor would have in the absence of the contract or agreement; b. Any express warranty unauthorized by you; e, Any physical or chemical change in the product made intentionally by the vendor; d Repackaging, except when unpacked solely tot the purpose of inspection, demonstration, tasting, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; I. Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or h. Bodily Injury, property damage or environmental damage arising out of the sole negtigenoe of the vendor for its own acts or omissions or those of its employees or anyone also acting on its behalf. However, this exclusion does not apply to: (1) The exceptions contained in Sub -paragraphs d. or I. above; or (2) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. As respects a manager or lessor of premises, a lessor of leased equipment, or a mortgagee, assignee, or receiver, this insurance does not apply to: (1) Any occurrence which takes place after the equipment lease expires or you cease to be a tenant. (2) Structural alterations, new construction or demolition operations performed by or on behalf of the manager or lessor of premises, or mortgagee, assignee, or receiver. 5. Any person or organization that has at least a 50% controlling interest in you but only with respect to bodily Injury, property damage, environmental damage or personal and advertising Injury caused, in whole or in part, by your acts or omissions of the acts or omissions of those acting on your behalf, arising out of their financial control of you. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture, or limited liability company unless a current or past partnership, joint venture, or limited liability company is an insured pursuant to paragraphs 1. through 5. above. Applicable to Coverage D Each of the following is an insured under Coverage D: The Named Insured designated in the dedarabons and any past or present director, officer, partner, member or employee thereof, while acting within the scope of his or her duties as such. SECTION III - LIMITS OF INSURANCE AND DEDUCTIBLE 1. The Limits of Insurance shown in the Declarations and the rules below fix the most we will pay regardless S435B (4107) C13053 Page 25 of 44 OP ID: CB ACORO CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDYYYY) 06/09/11 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:,df 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 staterneirf on this certificatedoes not confer rights to the - --certificate holder in lieu.of such endorsemenrys).- ... -.801-924-1400-:- .PRODUCER _,. _- _ ._._ ._ ,. - The Presidio Group, Inca '801-924-1441 5295 South 300 West #556. - - Salt Lake City, UT 84107 Alan W. Lord CIC, CWCA ,.., NAME PHONE - FAX _AIq— _c, No, Ex _. _ (AIC, No)__—_ -- -- -- E-MAIL - .• -ADDRESS: PRODUCER -----------_--- - - --- CUSTOMER ID #:-MAXPR1 INSURERS) AFFORDING COVERAGE I NAI N INSURED Maxwell Products, Inc. 650 S Delong Street Salt Lake City, UT 84104 wsuRERA_Ironshore Insurance Ltd. INSURER B: Colorado Casualty Insurance 141785 _ INSURER C: Employers Insurance Group_ INSURER D: _ INSURER INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS 10 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 PER'IFAIN, THE INSURANCE AFFORDED 13Y 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. — _ _ __ —. r - _j INSR -`_ -TypE OF INSURANCE. .._._. ADDLSUBRI POLICY NUMBER LMMLDD YVVV MMLDOYYVV LIMITS R " A', GENERAL LIABILITY n. c. -.'., -9•.: C.. X'COMMERCIAL GENERAL LIABII IIY ,X, - ... 00022800104/OS/11 04/0$/12111nMAG[70 DAMAGET( wB-- EACH OCCURRCN CEucuL- RENT[[) 2,000,00 ,' . $ ' 500,00 TCLAIMSMADE,I X ] OCCUR-, .. _ "' MED EXP(nryonepersan) $-_ 25,08 PERSONALdnDV INJURY $ Z,000,OO - - .. .. GI NFRAL AGGREGATE _.. Is -. 4,000,00 .... _ .. . .. ... GEN'L AGGREGATEI.IMIT APPL I ES PER PRODUCTS - COMP/OP AGG I$ 2,000,00 RoucY PRD- LOC CT Pollution Is 2,000,00 B AUTOMOBILE LIABILITY ANY AUTO - nILDWNED AUNOS SCIIEDIILED AU I OS HIRED AUTOS BA8683295 06/12/11 06/12/12 COMBINED SINGLE LIMIT (Ea acciden0 $ 1,000,00 - BODILY INJURY (Per brs.r) is BODILY INJURY(Per acoitlent) $ X PROPER iV DAMAGE (Pur.Rb,tl) $ X NON -OWNEDAUTOS X $ UMBRELLA LIAR OCCUR ' 6nCfl CCCUIERENGG I.3 jI AGGIt E__GnTE 4$ EXCESS LIAS CLAIMS-MA[ll3 f— DEDUCTIBLE -— Is RETENTION $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY' YIN ANY PROPRIeTORIPARTNEwexecUTIVe OFFIGERIMEMIII2R E%CLUDEU? NIA FN0329778-06 08/01/10 O8/01/11 WC Si MIU OT I X. TORY f IMITS. ER El_EnCn nccloENT 5 100,00 DISEASE -EA Li P S 100,00 (Mari le Nfq __I If under descRIPTION jE.L. I E.L. DISEASE -POLICY LIMIT I $ 500,00 Dyes DESCRIPTION 01:O OPERATIONS Uclnw B (inland Marine IM8696815 06/12/11 06/12/12 177,600 (Equipment Ded 1,00( DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Subject to the terms and conditions of the policy. City of Fort Collins is shown as additional insured as respects general liability per form 94358(4/07)attached. CITYFOR City of Fort Collins Purchasing Division PO Box 580 Fort Collins, CO 80522 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 REPRESENTATIVE - ';-:..----. Q "lye8-2U09 AL;URU CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD i respects any physician, dentist, nurse, emergency medical technician or paramedic who is employed by you to provide such services, provided you are not engaged in the business of providng such services. (2) Property damage or environmental damage to property: (a) Owned, occupied or used by, (b) Rented to, in be care, custody or control of, or over which physical control is being exercised for any purpose by you, any of your employees, volunteer workers, any partner or member (if you are a partnership or joint venture), or any member (if you are a limited liability company). b. Any person (other than your employee or volunteer worker) or any organization while acting as your real estate manager. c. My person or organization having proper temporary custody of your property if you die, but only: (1) With respect to liability arising out of the maintenance or use of that property; and (2) Until your legal representative has been appointed. d. Your legal representative if you die, but only with respect to duties as such. That representative will have all your rights and duties under this Policy. e. Any subsidiary, associated, affiliated or allied company or corporation, including subsidiaries thereof, of which you have more than 50% ownership interest as of the inception date of this Policy. 3. My organization you newly acquire or form, other than a partnership, joint venture, or limited liability company, and over which you maintain ownership or majority interest, will qualify as a Named Insured if there is no other similar insurance available to that organization. However: a. Coverage under this provision is afforded only (a) until the 180Ih day after you acquire or form the organization or the and of the policy period, whichever is earlier, (b) provided that you give us written notification within 180 days of the date of such acquisition or formation or before the end of the policy period, whichever Is earlier, and (c) If an additional premium, calculated by the company using its reasonable underwriting discretion but not to exceed 100% of the policy premium at inception, is paid when due; b. Coverage A and E do not apply to bodily Injury, property damage or environmental damage that occurred before you acquired or formed the organization; and c, Coverage B does not apply to personal and advertising Injury arising out of an offense committed before you acquired or formed the organization. 4. Except as respects to Coverage E-4, any person or organization with whom you agreed to include as an insured, because of a written contract, written agreement or permft, but only with respect to bodily Injury, property damage, environmental damage or personal and advertising Injury caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf, arising out of your operations, your work, equipment or premises leased, rented or owned by you, or your products which are distributed or sold in the regular course of a vendor's business, however: As respects vendors, this Insurance does not apply to: a. bodily injury, property damage or environmental damage for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not 94358 (4107)- C13063 Page 24 of 44