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HomeMy WebLinkAboutSIMPSON ELECTRIC INC - INSURANCE CERTIFICATE (5)A`� �® CERTIFICATE OF LIABILITY INSURANCE 2�13/201z2 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 First Mainstreet_ Insurance, LLC 275 S. Main Street, Suite 100 CONTACT Debbie Brickham I _NAME: -PHONE E,,): (303)776-5122 FAX Rp): (303)776-5495 E-MAIL-ADDREs: dbrickham@Firs tt4ainStreet. coon P.O. BOX 847 PRODUCER 00001838 CUSTOMER 10 0: INSURER(S) AFFORDING COVERAGE HAIG# Longmont CO 80502 INSURED mn25682 INSURER A:Travelers Indemnity Co. of CT P Simpson Electric, Inc. INSURERB:Owners Insurance Company I INSURERC:Travelers Indemnity Co. '25658 DBA: Simpson Electric of Colorado 1920 Glenview Court INSURERD:Pinnacol Assurance INSURER E : 1 INSURER F: Berthoud CO 80513 COVERAGES CERTIFICATE NUMBERS12--13 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 TYPE OF INSURANCE IADOOISUBR LTR EXP POLICY NUMBER M ID131YYYY MM/DDY EFFYIYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE COCCUR 6803299C359 2/20/2012 2/20/2013 _ EACH OCCURRENCE DAMAGE TO RENTED 1P_REMISES. Ea occurrence) MEDEXP(Any one person) $ 1,000,000 $ 300,000 Is 5,000 PERSONAL S ADV INJURY Is 1,000,000 GENERALAGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRO LOG X POLICY I Ij PRODUCTS-COMPIOP AGG Is B AUTOMOBILE UASIUTY ANY AUTO ALL OWNED AUTOS SCHEDULEDAUTOS HIRED AUTOS NON -OWNED AUTOS 4268565900 11/24/201111/24/2012 COMBINED SINGLE LIMIT (Ea accieenp $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) I $ X X Uninsured moionst BI-single $ 1,000,000 Medical payments Is 5,000 C _ X UMBRELLA UAB OCCUR EXCESS UABCLAIMS-MADE 1 CUP8126C161 Does not include Auto (Liability 2/20/2012 2/20/2013 I EACH OCCURRENCE I$ 1,000,000 AGGREGATE $ 1,000,000 DEDUCTIBLE RElENI'ION $ - 5000 $ X D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If as, describe under DESCRIPTION OF OPERATIONS below NIA 149582p 4/1/2011 4/l/2012 X TORYLIMITSLLOER_I E.L. EACH ACCIDENT is I,_Poo, OOO E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT I $ 11000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Rem s Schedule, it more space is re uired) (970)224-6134 City of Fort Collins Attn: Mary Jane P.O. 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 Brickham/DBRICK— ACORD 25 (2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025 (2D0909) The ACORD name and logo are registered marks of ACORD SENTRY INSURANCE A MUTUAL COMPANY STEVENS POINT, WISCONSIN (A PARTICIPATING MUTUAL COMPANY) A MEMBER OF THE SENTRY FAMILY OF INSURANCE COMPANIES 0 0 r� U CERTIFICATE OF INSURANCE ACCOUNT NUMBER 25-39665 This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policies below. Name and Address of Certificate Holder. THE CITY OF FORT COLLINS ATTN: KATHY 700 WOOD ST PO BOX 580 FORT COLLINS, CO 80522 Name and Address of the Insured BETZ TRANSFORMERS INC PO BOX 729 OLATHE, CO 81425 This certificate is issued on 01-22-2012 and is effective until 01-01-2013. It certifies that policies of insurance listed below have been issued to the insured named above. 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. Coverage Provided General Liability Bodily Injury and Property Damage Combined Automobile Liability Includes: Bodily Injury and Property Damage Combined -Any Auto Policy Number Coverage Limits 25-39665-02 General Aggregate S 3,000,000 Products Aggregate S 1,000,000 OCCURRENCE Pers/Adv Injury $ 1,000,000 Each Occurrence S 1,000,000 Premises Damage S 150,000 Medical Expense S 10,000 25-39665-02 Each Accident 1,000,000 Excess/Umbrella 25-39665-02 Each Occurrence $ 1,000,000 Liability General Aggregate $ 1,000,000 Products Aggregate $ 1,000,000 Should any of the above described policies be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy provisions. 80-C1035 (MECH) BET 25-39665 02-03-2012 PAGE 1 (0008) 31-060502 LDI COI 269628-1 02 11 o „ox 12048 SENTRY INSURANCE A MUTUAL COMPANY THE SENTRY PLAN STEVENS POINT, WISCONSIN POLICY (A PARTICIPATING MUTUAL COMPANY) A MEMBER OF THE SENTRY FAMILY OF INSURANCE COMPANIES • GENERAL LIABILITY DECLARATIONS NAME INSURED: BETZ TRANSFORMERS INC ADDITIONAL INSURED SCHEDULE POLICY NUMBER 25-39665-02 The following information is required to complete the accompanying additional insured endorsement which forms a part of the Named Insured's COMMERCIAL GENERAL LIABILITY COVERAGE PART. ADDITIONAL INSURED ENDORSEMENT THE CITY OF FORT COLLINS CG 32 29 06 10 ATTN: KATHY 700 WOOD ST PO BOX 580- FORT COLLINS, CO 80522 (CERTIFICATE NUMBER 0008) LOCATION(S) OF COVERED OPERATIONS 700 WOOD ST PO BOX 580 FORT COLLINS, CO 80522 CG 89 01 11 85 (MECH) BET 25-39665-02 40 120 02-03-2012 (000 0008) FOR ENDORSEMENT TEXT, SEE OVER. EFFECTIVE FROM JANUARY 22, 2012 TO JANUARY O1, 2013 O ITIflOflG 12281