HomeMy WebLinkAbout104571 GREGORY ELECTRIC INC - INSURANCE CERTIFICATE (5)UP ILI: KC
CERTIFICATE OF LIABILITY INSURANCE DAT06/06112 )
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
IFS Insurance Group - JT
$848 Thompson Pkwy, Ste 200
Johnstown, CO 80534
John Hintzman
INSURED
3317 N. Lincoln Ave. INSURERB:
Loveland, CO 80538
INSURER C
Travelers
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 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.
ILTR TYPE OF INSURANCE ADDLIMIDEUBRI POLICY NUMBER MMIDD VYYY MMIDDIYEYYY LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,DBB,BB
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE I -XI OCCUR
C01741R171
10/01/11
10101/12
DAMAGE TO RENTED
PREMISES -(Ea occunence
MED EXP (Any one person)
E 300,00
$ 10,00
X Blanket Add'I Ins
PERSONAL B ADV INJURY
$ 1,000,00
X
Blkt Waiver
GENERAL AGGREGATE
$ 2,000,00
LIMITED POLLUTION
GEN'L AGGREGATE LIMIT APPLIES PER:
�$
POLICY 1l PRO-n LOC
PRODUCTS - COMP/OP AGG
$ 2,000,00
A
AUTOMOBILE
LIABILITY
ANY AUTO
BA9748R372
10/01/11
10/01112
COMBINED SINGLE LIMIT
(Ea accident)
E 1,000,000
X
BODILY INJURY (Per person)
$
ALL OWNED AUTOS
BODILY INJURY (Per accident)
$
A
SCHEDULED AUTOS
HIRED AUTOS
PROPERTY DAMAGE
(Per accident)
$
X
X
$
A
NON -OWNED AUTOS
BLANKET ADD'L INS.
$
BLANKET WAIVER
HUMBRELLA
LIAB X OCCUR
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 5,000,000
A
EXCESS LIAB j--� CLAIMS -MADE
CUP9748R372
10/01/11
10/01112
HDEDUCTIBLE
$
RETENTION $ 10,000
Is
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNER/EXECUTIVE YIN
OFFICER/MEMBER EXCLUOE09
(As,d ory In NH)e
N/A
4014736
BLANKET WAIVER OF SUBRO
07I01/12
07I01113
X WESTATU- IOTH-
TORY LIMITS�ER
e.L. EACH ACCIDENT
$ 1,000,000
EL.DISEASE - EA EMPLOYEES
1,000,00
be ander
DE CRIPTIONOFOPERATIONS below
S
E.L. DISEASE -POLICY LIMIT 1
$ 1,000,00
A /Installation
'8137P230
10/01/11
10/01/12
Install 2,000,000
IDed
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AKach ACORD 101, Addltlonal Remarks Schedule, If more space is required)
If required by written contract or written agreement the following
provisions apply subject to the policy terms, conditions, limitations and
exclusions: The Certificate Holder is included as Additional Insured for
ongoing and completed operations under General Liability. Exception:
10 days written notice of cancellation for non-payment of premium.
CITYFCC
CITY OF FORT COLLINS
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
01988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD