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HomeMy WebLinkAbout473287 SHORT-ELLIOTT-HENDRICKSON INC - INSURANCE CERTIFICATE (4)ACORD CERTIFICATE OF LIABILITY INSURANCE iM F -GATE 09/28/2012 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 H. Robert Anderson & Assocs., Inc. 8201 Norman Center Drive Suite 220 I 1 Bloomington, NN 55437 lX ti CONTACT NAME: PHONE 952.893.1933 NCINo Eat: (A/C,No:952.893.1819 ADDRESS: INSURERS) AFFORDING COVERAGE NAICN INSURERA: XL Specialty Insurance Co. INSURED Short -Elliott -Hendrickson, Inc. INSURER B: SEH, Inc. INSURER C: 3535 Vadnais Center Drive INSURER D: St. Paul, NN 55110 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 10/12-13 PL 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 TYPE OF INSURANCE ADO INSR MD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDDNYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE S PREMISES (Ea NTLU occurrence) $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & AOV INJURY It GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER'. PRODUCTS AGG $ POLICY PRO- LOC ECT $ AUTOMOBILE LIABILITY (Ea accitlent) $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accitlenl ( ) $ HIRED AUTOS NON -OWNED AUTOS (Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNEWEXECUTIV OFFICERIMEMBER EXCLUDED? NIA TORV LIMITSI I ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEEI S (Mandatory In NH) If yes, describe under E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below Professional Liability DPR96998871110112012 10/01/2013 Each Claim/ $5,000,000 A Annual Aggregate $10,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Romarm Schedule, if more apace Is required) This certificate or memorandum of insurance does not affirmatively or negatively amend, extend, or alter the coverage afforded by the insurance policy. vuv a ,vn, � VArII.CLLA I IUIN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins 300 LaPorte Ave Forst Collins, NN 80521 All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 73905 ALA o® CERTIFICATE OF LIABILITY INSURANCE DAT 9/27/2012 9/27/2012 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 endomement(s). PRODUCER CONTACT Dorothy Stabler NAME: y Commercial Lines - 952 830-3000 ( ) FAX PHONE FAX 952-563-0528 .(AIC..No Est)' INC, No): E-MAIL lhorostabler wellsfar m ADDRESS: dy' o.co @ 9 Wells Fargo Insurance Services USA, Inc. INSURER(S) AFFORDING COVERAGE NAIC N 4300 MarketPointe Drive, Suite 600 INSURER A: Wausau Business Insurance Company 26069 Bloomington, MN 55435-5455 INSURED INSURER B: Depositors Insurance Company 42587 SEH, Inc. INSURER C: Liberty Insurance Corporation 42404 Short -Elliott -Hendrickson, Inc. INSURER D: Liberty Mutual Fire Insurance Cc 23035 INSURER E: 3535 Vadnais Center Drive INSURER F: St. Paul, MN 55110 COVERAGES CERTIFICATE NUMBER: 4921840 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. INBR ADOLSUTYPE OF INSURANCE INSR WINK LTR POLICY NUMBER MMIDDYYYY Y MMIDD YYY) LIMITS A GENERAL LIABILITYEACHOCCURRENCE X COMMERCIAL GENERAL LIABILITY YVK Z91 455380 022 10/01/12 10/01/13 -DAMAGE TO RENTED PREMISES (Ea oceurrencel_ $ 1,000,o00 $ 1,000,000 CLAIMS -MADE OCCUR MED EXP(My one person) $ 10.000 PERSONAL S ADV INJURY $ 1p00,000 GENERAL AGGREGATE $ 2.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 POLICY X PRO 5-1 LOC Combined Total Aggregate $ 15.000,000 B AUTOMOBILE LIABILITY ACP 7171965099 10/01/12 10/01/13 COMBINEDSINGLE LIMIT -(Ea accidare 1,000,000 # BODILY INJURY (Per person) $ % ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accidonl) $ ANONGOWNED X MIRED AUTOS N _ PROPERT nt)AMAGE $ 8 C X I UMBRELLA LIAB % OCCUR TH7 Z91 455380 032 10/01/12 10/01/13 EACH OCCURRENCE $ 7,000.000 71 AGGREGATE $ 7,000.000 EXCESS LIAR CLAIMS -MADE DEO I % I RETENTION $ 10.000 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOMPARTNEMEXECUTIVE OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) NIA WC2 Z91 455380 012 10/01/12 10/01/13 X WC STATU- OTH- FLY EMT E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE EA EMPLOYE $ 1,000.000 If yes, describe under DESCRIPTION OF OPERATIONS W. E.L. DISEASE POLICY LIMIT E t 000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER IS ADDITIONAL INSURED AS REGARDS GENERAL LIABILITY FOR WORK PREFORMED BY NAMED INSURED WHEN REQUIRED BY WRITTEN CONTRACT City of Fort Collins 300 La Porte Avenue Fort Collins MN 80521 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 OUI<]U The ACORD name and logo are registered marks of ACORD © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 11111111 III IIIIIII 111111111111111 IIII IIIII 111111111111111lIIII 1111111111 IIIII 11111 IIII IIII