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Home My WebLink About475768 TRINITY STRUCTURAL COMPONENTS LLC - INSURANCE CERTIFICATEACORN® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIODNYYY) 6 23 2011 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 . PRODUCER CONTACT NAME: McQueary Henry Bowles Troy, L.L.P. 8144 Walnut Hill Lane, 16th F1 Dallas TX 75231 PHONE FAx - AIc No: - 7 - E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC N INSURERA:ACS—Rmerican Insurance Compally-22667 INSURED TRI NI IND 1 INSURER B INSURER C: Trinity Structural Components, LLC P O Box 568887 Dallas, TX 75356-8887 INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 898177280 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 rypE OF INSURANCE ADDL INSR UBR MID POLICY NUMBER POLICY EFF MMIDDNYYY POLICY EXP MM/DDIYYYY LIMITS A GENERAL LIABILITY HIDOG25523994 /I/2011 /1/2012 EACH OCCURRENCE $500,000 X COMMERCIALGENERAL LIABILITY CLAIMS -MADE OCCUR DAMA ETO RENTED PREMISES ffa occurrence $50,000 MED EXP(My ona person) $30,000 PERSONAL B ADV INJURY $500,000 GENERAL AGGREGATE $500,000 GENT AGGREGATE OMIT APPLIES PER: PRODUCTS - COMP/OP AGG $500,000 X POLICY PRO- LOC $ A OMOBILE LIABILITY IS81 /1/2011 /1/2012 500000 BODILY INJURY(Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS P BODILY INJURY(Per accident) $ % NONdWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident S UMBRELLA LAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNEWEXECUTNE OFFICER/AIEMBER EXCLUDED? N❑ NIA LRC46477960 /1/2011 /1/2012 X WC STATU- OTH- -LI E.L. EACH ACCIDENT $100, 000 E.L. DISEASE - EA EMPLOYE $100,000 (Mandator, in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT 1 $100, 000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule. If more space Is required) Additional Insured Form CG20 26 Edition 07/04 applies to General Liability Additional Insured Form CA20 48 Edition 02/99 applies to Automobile Liability City of Fort Collins, its officers, agents and employees are added as Additional Insured on the General Liability and Automobile Liability policies of the insured but only to the extent that the limits and forms are required to satisfy the terms of a written contract. City of Fort Collins Attn: Purchasing P O 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 0 ACORD CORPORATION_ All rinhfs ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD