HomeMy WebLinkAbout480152 FORD AUDIO-VIDEO SYSTEMS INC - INSURANCE CERTIFICATEClient#: 191
FORDAUD
ACORD.. CERTIFICATE OF LIABILITY INSURANCE
O
01105120(MWDO712YYI
ovos/zott
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
CONTACT Nancy Hansen
NAME
Willis of Oklahoma, Inc.
PHONE 405 552-4819 FAX 4D5 552-4419
(AICr Nor_Est): L(AICN-):
211 N Robinson, Suite700 Snanc
E-MAIL: Y hansen willis.com
ADDRESS:
Oklahoma City, OK 73102-7105
405 232-0651
INSURERIS) AFFORDING COVERAGE
NAIC#
Continental Casualty Co.
INSURER A: Y
20443
INSURED
INSURER B: St. Paul Fire and Marine Ins. C
24767
Ford Audio -Video Systems, Inc. 1��� �5 v
an RLI Insurance Company
INSURER c: P Y
13056
4800 West Interstate 40
INSURER D: Travelers Cas 8 Surety Co of Am
31194
Oklahoma City, OK 73128-5425
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 CONTRACTOR OTHER DOCUMENT W1 TH 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
ADDL
MISS
SUBS
MD
POLICY NUMBER
POLICY EFF
(MWOONYYY
POLICY EXP
(MMIDDIYYYY)
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
_ Cl-AIMS-MADE 51 OCCUR
X
X
U2048180671
12/31/2011
12/31/2012
EACHOCCURRENCE
$1,000,000
DAMAGE T RENTED
PREMISES RENTED
PREMISES
$100,000
MED EXP (Any one parson)
S 5,000
PERSONAL B ADV INJURY
$1,000,000
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY FX PE O LOC
PRODUCTS-COMPIOP AGO
$2,000,000
$
D
AUTOMOBILE
LIABILITY
ANYAUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
HIRED AUTOS X NON -OWNED
AUTOS
rive Oth Car
X
X
Y8109A712064TIL11
12/31/2011
12131/2012
EOMBINdEEDISINGLE LIMIT
$1,000,000
X
BODILY INJURY (Per person)
$
_
BODILY INJURY P
Per accident )
$
X
PROPERTY DAMAGE
Peracddenl)
$
X
$
B
X
UMBRELLALIAB
EXCESS LIAB
X
OCCUR
Cl-AIMS-MADE
I
QK08500402
12131/2011
12/3112012
EACHOCCURRENCE
S5,000 000
AGGREGATE
$5,00D,UD0
OED F1 RETENTIONS10000
S
A
WORKERS COMPENSATION
ANDEMPLOVERS'LIA8ILITY YIN
ANY PROPRIETORIPARTNERIEXECUTNE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
It yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
4025699758
12/31/2011
'12/31/2012
X WC $TATU- OTH-
S PH
E.L. EACH ACCIDENT
s500OOO
E.L. DISEASE- EA EMPLOYEE
$500,000
EL DISEASE - POLICY LIMIT
$1,000,000
C
Installation
Floater
ILM0702234
12/31/2011
12/31/201
$5,000,000 Limit
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required)
Ford AV Job #1104361 - The City, its officers, agents and employees are additional insureds in regards to
the Lincoln Center Canyon West Audio[Video project.
City of Fort Collins
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
(71988-2010 ACORD L`n RPORATiDN All rinhtc --reoof
ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S251456/M251394 NMH