HomeMy WebLinkAbout473287 SHORT-ELLIOTT-HENDRICKSON INC - INSURANCE CERTIFICATE (5)73905
�® CERTIFICATE OF LIABILITY INSURANCE
E (MMIODNY")
DAT9/2712011
9/27/2011
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 endomement(s).
PRODUCER
Commercial Lines - (952) 830-3000
Wells Fargo Insurance Services USA, Inc.
MarketPoinle Drive, Suite 600
CONTACT
NAME:
PHONE FA%
AIC. No. AIC No):
ADDRESS:
E-NI4300
INSURERS AFFORDING COVERAGE
NAILIf
Bloomington, MN 55435-5455
INSURERA: Wausau Business Insurance Company
26069
INSURED SEH, Inc.
INSURER B: Nationwide Mutual Insurance Company
23787
INSURER c: Liberty Insurance Corporation
42404
Short -Elliott -Hendrickson, Inc.
INSURER D :
3535 Vadnais Center Drive
INSURER E :
St. Paul, MN 55110
INSURER F:
COVERAGES CERTIFICATE NUMBER: 3304657 REVISION NUMBER: See below
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
SUBR
POLICY NUMBER
POLICY EFF
MWDDIYYYY
POLICY EXP
MMIDDrYvY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS-MADEMOCCUR
YVK Z91 455380 021
10/01/11
10/01/12
EACH OCCURRENCE
$ 1,000.000
DAMAGE ( RENTED
PREMISESS Ea NTED ra)
$ 1.000,000
MED EXP(Any one person)
$ 10.000
PERSONAL B ADV INJURY
$ 1,000.000
GENERAL AGGREGATE
$ 2,000,000
GENT AGGREGATE
POLICY
LIMIT APPLIES PER:
PRO X LOG
X
PRODUCTS - COMP/OP AGG
$ 2.000.000
Combined Total Aggregate
$ 15=000
B
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIRED AUTOS AUTOS
7161965099
10/01/11
10/01/12
COMBINED SINGLE LIMIT
Ea accident
1,000,000
X
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident
$
PROPERTY DAMAGE
Per accident
$
G
X
UMBRELLA LIAD
EXCESS LIAR
%
OCCUR
CLAIMS -MADE
TH7 Z91 455380 031
10/01/11
10/01/12
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 5,000.000
DED I % I RETENTION$ 10,IX10
$
C
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY YIN
ANY PROPRIETORIPARTNER/EXECUTIVE
OFFICERP EMBER EXCLUDED] F_N]
(Myyandator, In NH)
es, drd�rmu, under CRPT!04 O.c OPERATIONS Wi,
DES
N I A
WC7 Z91455380011
10/01/11
10/01/12
X I WC STATU- OTH-
E.L. EACH ACCIDENT
$ 1,000.000
E.DISEASE - EA EMPLOYE
$ 1,000,000
EL. DISEASE POLICY LIMIT
$ 1•�•�
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
CERTIFICATE HOLDER IS ADDITIONAL INSURED AS REGARDS GENERAL LIABILITY FOR WORK PREFORMED BY NAMED INSURED WHEN
REQUIRED BY WRITTEN CONTRACT
City of Fort Collins
300 La Porte Avenue
Fort Collins MN 80521
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
9/
The ACORn name and Irvin am renislarad marks of ACnPn n 1gRR_9Mn ArnRn rnPPnRATInN All .i..Hie .e�e..•ed
ACORD 25 (2010105)
(This m,l emuo" 1M.11. er9T(A11)