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HomeMy WebLinkAbout263373 ELECTRONIC SYSTEMS INTERNATIONAL INC - INSURANCE CERTIFICATE (5)OP ID: SG At`oRo CERTIFICATE OF LIABILITY INSURANCE DATE12//31 N 111 YYY) 2 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`certiftcate does not confer rights to the certificate holder in lieu of such endorsements . - - PRODUCER _ 719-590-9990 Six & Geving Insurance, Gie., — - 719-590-9992 3630 Sinton Road, Suite 200_ _ Colorado Springs, CO 80907-5034 :9 Randy Geving CONTACT NAME, Suzanne Storm AID No EXt:719-590-9990 a No:-719-590-9992 E-MAIL ADDRESS, sstorm@six-geving.com PRODUCER CUSTOMER toek ECT-1 INSURERS AFFORDING COVERAGE NAIC N INSURED Electronic Systems International, Inc. 3010 Mallard Drive Colorado Springs, CO 80910-2247 INSURER A: COVerx Corporation INSURER B: Pinnacol Assurance 41190 INSURER C: Acuity14184 INSURER D INSURERS: INSURER F: 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. INSR TR TYPE OF INSURANCE ADDL U POLICY NUMBER MMIDDIYYYY POLICY DDIYYYY LIMITS A -' GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [XIOCCUR PENDING ELECT-1 - . 01101113 01101/14 - EACH OCCURRENCE $ 1,000,00 PREMISES EaoccEence $ 50,00 MED EXP(My one Person) $ 5,00 PERSONAL S ADV INJURY $ GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER 1-1 POLICY PRO- LOC' IECT PRODUCTS. COMPIOP AGG $ 2,000,00 ,. C AUTOMOBILE LIABILITY..,.. ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS - _ L75688 01/01/13 01/01/14 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY(Per person) $ BODILY INJURY (Per accident) $ PROPERTYDAMAGE (Per accident) $ If 8 UMBRELLA LIAR EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICERIMEWER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A 4076606 01/01/13 01/01114 X WC STATU- OTH- E.L. EACH ACCIDENT $ 500,00 E. L. DISEASE - EA EMPLOYEE $ 500,00 E.L. DISEASE - POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) i CITYF-2 City of Ft. Collins Director of Purchasing and Risk Management P.O. Box 580 Ft. Collins, CO 80522-0580 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 /ff"? &e4; ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD