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ACORO® CERTIFICATE OF LIABILITY INSURANCE
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°020712 13
0/7/20
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: Ifthe certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. N 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 a .
PRODUCER
CONTACT
M K Stave RAOdaZ20
Security Insurance Group, LLC
PHO"� 970478481e uC NeL 970-378�820
PD�RESs.
8219 W 20th St, Ste A
steve�aecurit�ineuraneegroup.not
INSURERSAFFORDINGCOVERAGE
NAICN
Greeley, CO80634
INSURER A: Auto Owners Insurance
INSURED
INSURER e: Owners Insurance Company
INSURER C:
Schwartz Electric, LLC.
INEURERD:
606 Diamond Dr
INsoRERE:
Fort Collins, CO 80525-4221
M5110.E0. F:
GUVtHAGES CERTIFICATF NIIMRFR- MM10A11inRA1 RFVLGIrTN NIIMRFR. a
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,
ILER
TYPE OF INSURANCE
DL
1.
6U
PDLICY NUMBER
POLICY EFF
POLICYEYP
IJMITS
A
OENERALLIABILItt
GENERAL IrABIOtt
CLMMS-MADE a OCCUR
N
N
74007284
10/01/2012
10/01/2013
-
EACH OCCURRENCE
S 1000000
-ffCOMMERGAL
REAI N�rrerv0
S 300000
MED EXP ( o1e 7
S 10,000
PERSOMLSADVINJURY
S 1000000
GENERALAGOREGATE
E 2.000.000
GENL AGGREGATE
POLICY
LIMIT APPLIES PER:
PRO LCC
PRODUCTS COMP/OP AGG
S 2.000.000
S
B
AUTOMOBNJELIABILITY
I ANY AUTO
ALLCVMED SOHEDULED IAUTOS
H I
HIRREDED AUTOS NONE ED
AUTtl
N
N
4775620700
OW22/2012
0922/2013
COMBINED SINGLE OMIT
00
BODILYINJURY(Perwe )
t
BODILY INJURY (Pxr O)
S
PPROPERe DAMAGE
t
t'
UMBRELLA LIAR
EXCESS LUa
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
S
AGGREGATE
S
DIED RETENTIONt
E
WORI(ERS COMPENSATION
ANOENPLOYERS'LIABILItt YIN
ANY PROPMETORJPARTNERI ECUMIVE
OFFICERMEMBER EXCLUDED? Q
(lur u,WNHi
syyeenn eee�m omv
DEECRIPTX)N OF OPERATIONS ENw
NIA
NC STATU- OTH-
E L. EACH ACCIDENT
$
E.L DISEASE - EA EMPLOYE
S
E.L. DISEASE - POLICY LIMIT
E
DESCRIPTION OF OPERATIONS I LOCAnONS /VEHICLES (ANaeh ACORO 1D1, AENUo,ul0.emerMe ScheUNe, N men egca b RRUIIW 1
City of Fort Collins Facilities
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORISED REPRESENTATIVE
T,r
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
Printed by SJR on February 07, 2013 at 01:01PM