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HomeMy WebLinkAbout263373 ELECTRONIC SYSTEMS INTERNATIONAL INC - INSURANCE CERTIFICATE (4)OP ID: SG A`co�Ro° CERTIFICATE OF LIABILITY INSURANCE DAT01/04D/YYYY) ovoan2 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 ._ .. - .. ._ -._ _. 719-590-9990 Six B Geving Insurance, Inc. 719-590-9992 3630 Simon Road, Suite 200 Colorado Springs, CO 66907-5034 Randy Graving CONT NAME: Suzanne Storm PHONE 719-590-9990 " :"':_,'._ :' ac no: 719-590-9992 AC No Eat: E-MAIL ADDRESS: sstorm@six-geving.com PRODUCER ELECT-1 v CUSTOMER 10 a: INSURERS AFFORDING COVERAGE NAIL N . -1 INSURED Electronic Systems ��� ,/ International, Inc. 3010 Mallard Drive Colorado Springs, CO 80910-2247 INSURER A: COVerx Corporation INSURER B: Pinnacol Assurance 41190 INSURER C:Acuity 14184 INSURER D INSURER E : INSURER F rnVFRAr;FS 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. INSR TR TYPE OF INSURANCE INm B POLICY NUMBER POLICY EFF MM/DONYW POLICY EXP MM/DDNYYY LIMITS A ... - GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS-MADEaOCCUR '.. ' SECGL339101 ...' :_ .. s ..---. .., ._._ 01/01/12 . _... - ,._._ 01101113 .._ ..PERSONAL .-..,.PRODUCTS-COMP/OP,AGG EACH OCCURRENCE $. 1,000,00 PREMISES Eaoccurrence $- .50,00 MED EXP(My one person) $ _ 5,00 &ADV INJURY... .$.. . .. .... . LJ _+. GENERAL AGGREGATE _._ ..8 2,000,00 GEN'LAGGREGATE LIMIT APPLIESPER ' POLICY PRO= LOC. $ _2,000,00 $ C AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS L75688 01101/12 01/01/13 COMBINED SINGLE LIMIT (Ea accident) $ 1,060,00 _ _ X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ UMBRELLA LIAB EXCESS LIP B OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE '- RETENTION $ - $ _ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICER/MEMBER EXCLUDED9 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below MIA 4076606 D11D1112 01/01113 X -WC R STATU OTR- EL EACH ACCIDENT $ 500,00 E. L. DISEASE EA EMPLOYEE $ 600,00 E.L. DISEASE - POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace is required) CITYF-2 City of Ft. Collins Director of Purchasing and Risk Management P.O. Box 580 Ft. Collins, CO 80522-0580 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 W"� &kk_ ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD