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Home My WebLink About116689 BETZ TRANSFORMERS - INSURANCE CERTIFICATE (2)ll'i CERTIFICATE OF LIABILITY INSURANCE �i °ATE(8/201yY) lz/ze/2ou 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 Moody -Valley Insurance Agency, Inc. PO Box 1509 604 25 Road Grand Junction CO 81502 CONTACT Ginnie Smith, CISR NAME: PHONE (970) 248-8300 ac No: (970)242-1994 aDpAIL .gsmi th@moodyins. com INSURERS AFFORDING COVERAGE NAIL# INSURER A:Travelers Indem Cc of CT 25682 INSURED Betz Transformers Inc. 320 Industrial Ave Olathe CO 81425 INSURER B:Charter Oak Fire Ins CO 25615 INSURERC:St. Paul Fire 6 Marine Ins 24767 INSURER D:Pinnacol Assurance 41190 INSURER e:Northland Insurance Cc INSURER F: COVERAGES CERTIFICATE NUMBER:12/13WC11/12GLBAEXCargo 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 OF INSURANCE AODILSUTYPE BR POLICY NUMBER EFF MMIDDPOLICYIYYYY MML ICY EXP DDNYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 100, 000 A CLAIM&MADE OCCUR X Y630633M2927TCTII /22/2011 1/22/2012 MED EXP(My one person) $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY I PRO LOG $ AUTOMOBILE LIABILITY EOMaBMdEeDt SINGLE LIMIT 1,000,000 NON BODILY INJURY (Per person) $ B AUTO BODILY INJURY (Per acdtlenl) $ ALL OWNED SCHEDULED Y810633M2927COF11 /22/2011 /22/2012 AUTOS AUTOS PROPERTY DAMAGE NON,DWNED HIRED AUTOS AUTOS HIREDR5,000,000 Per accident Uninsured molonst combined X UMBRELLA LIAB OCCUR EACH OCCURRENCE AGGREGATE C. EXCESS LIABLAIMS-MADE X 10, 00 ❑RETENTION$ K08300851 1/22/2011 1/22/2012 D WORKERS COMPENSATION XWGSTATU- OTHAND MIJS ER EMPLOYERS'LIABILITY YIN E. L. EACH ACCIDENT MY PROPRIETOWPARTNEMEXECUTIVE OFFICEMMEMBER EXCLUDED? (Mandator, in NH) NIA 067927 /1/2012 /1/2013 E.L. DISEASE -EA EMPLOYE If yes, descnhe under DESCRIPTION OF OPERATIONS holaw E.L. DISEASE -POLICY LIMIT $ 1,000,000 E Cargo 0469294 1/22/2011 1/22/2012 Single Conveyancef$100.000 Deduct/$1,000 Except $2,000 Theft Ded DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If mare space is required) The City of Fort Collins is listed as Additional Insured regarding general liability. ktourmaschy@fcgov.com The City of Fort Collins Attn: Kathy 700 Wood Street 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 Smith, CISR/GINSMI==—�`-7 ACORD 25 (2010/05) n 1988-2010 ACORD CORPORATION All rinhfs INR075 Dmnnslm Thie ACORn nmm& End Innn vrn rnnicferad mnrbe of Arnpn