HomeMy WebLinkAboutTEPA EC LLC - INSURANCE CERTIFICATE (3)30305
ACOROCERTIFICATE OF LIABILITY INSURANCE
`„�
DATE (M 9/2011 Y)
1 Z2I2011®
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
Commercial Lines - (719) 592-1177
CONTACT Jennifer Walker
NAME:
PHONE 719-785-8119 FAX 877-4D5-9D32
-(NC,.N4. E._t),INC,No:
Wells Fargo Insurance Services USA, Inc.
EWAIL ennifer. wellsfar com
ADDRESS: 1 1".walker @ 9o.
INSURERLS) AFFORDING COVERAGE
NAIC If
5755 Mark Dabling Blvd., Suite 300
INSURER A: Zurich American Insurance Co
16535
Colorado Springs, CO 80919-2228
INSURED
INSURER B : American Guarantee and Liability Insurance Com
26247
TEPA EC, LLC
INSURER C :
5045 List Drive
INSURER D :
INSURER E :
INSURER F :
Colorado Springs, CO 80919
COVERAGES CERTIFICATE NUMBER: 3739837 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP
LTR POLICY NUMBER MMIDO/YYYYI (MMIDDIYMI LIMITS
A
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
IX
CPO 9806472-00
1/1/2012
1/1/2013
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES Ea occurrence
ocum
$ 1,000,000
b �
MED EXP(My one person)
$ 1C000
PERSONALS ADV INJURY
$ 1,000,000
Blanket AINIOS
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGO
$ 2,000,000
POLICY X PRO LOC
Employee Beretta
$ 1,000,000
A
AUTOMOBILE
LIABILITY
CPO 9806472-00
1/1/2012
1/1/2013
COMBINED SINGLE LIMIT
$ 1,000,000
X
BODILY INJURY (Per person)
$
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTS
O
BODILY INJURY Per accident)
$
PROPERTY DAMAGE
Per accident)
$
NON -OWNED
AUTOS AUTOS
XHIRED
$ $500 Compl$500 Coll
Hired Physics X $500 Com /$5
B
X
UMBRELLALIAB
X
OCCUR
CPO 9806472-00
1/1/2012
1/1/2013
EACH OCCURRENCE
$ 4,000.000
AGGREGATE
g 4,000.000
EXCESS UAB
CLAIMS -MADE
DED I X I RETENTION$ None
$
A
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY yIN
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICER/MEMBER EXCLUDED?
NIA
WC 9806473-00
1/1/2012
1/1/2013
X WC STATU OTM-
S_ E
E.L. EACH ACCIDENT
1,000.000
$ _
E.L. DISEASE -EA EMPLOYE
$ 1,000.000
(Mandatory In NH)
If yes, tleunme under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE -POLICY LIMIT
E 1,000,000
A
Leased/Rented Equipment
Installation Floater
CPO 9806472-00
01/01/2012
01/01/2013
$250,000
$250.000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ANach ACORD 101, Additional Remarks Schedule, if more space is required)
Certificate holder is recognized as an additional insured as respects: Contractors License fax:970-224-6134
City of Ft. Collins
P.O. Box 580
Fort Collins CO 805220580
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AL/THORVED REPRESENTATIVE
The ACORD name and logo are registered marks of ACORD
ACORD 25 (2010105) 1IIII111II1IIIIII II II II 111IIIIIII 111111111111IIIIIII it
All rights reserved.
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