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Home My WebLink About475768 TRINITY STRUCTURAL COMPONENTS LLC - INSURANCE CERTIFICATE (2)ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIOD Y) 6/27/2013 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 CONTACT NAME: MHBTInc. 8144 Walnut Hill Lane, 16th Floor Dallas TX 75231 PHONE FAX C No (97� O\ AI : - E-MAIL ADDRESS: INSURER(�AFFOROING COVERAGE NAICp 5 b INSURER A:Insurance INSURED TRINIINDI INSURER B INSURER C: Trinity Structural Components, LLC P O BOX 568887 Dallas, TX 75356-8887 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 818343040 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. LTR rypE OF INSURANCE ADDINSR L INSR Rl WVO POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS A GENERAL LIABILITY HDOG27021165 /1/2013 /l/2014 EACH OCCURRENCE $5,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE aOCCUR DAMAGE TO RENTED PREMISES Ea cccueence, $50,000 MED UP (My one person) $10,000 PERSONAL 8 ADV INJURY $5,000,000 GENERALAGGREGATE $7,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $7,000.000 ,X7 POLICY PRO- LOG $ A A AUTOMOBILE LIABILITY ANY AUTO ISAH08720228 ISAH0872023A /1/2013 11/2013 /112014 /1/2014 Ea accident 000000 X BODILY INJURY (Per person) $ ALL OWNED F I SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X NON -OWNED HIRED AUTOS X AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEO I I RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN /1/2013 71112014 X I WC STATU- OTH- All States E.L EACH ACCIDENT $2,000,000 ANY PROPRIETOWPARTNER]EXECUTIVE❑ OFFICEMMEMBER EXCLUDED? N NIA �LRC47320379 E.L. DISEASE- EA EMPLOYEE $2,000,000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE -POLICY LIMIT $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Certificate Holder includes: City of Fort Collins, its officers, agents and employees The General Liability policy includes a blanket additional insured endorsement to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. The Automobile Liability policy contains language that provides additional insured status to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. City of Fort Collins Attn: Purchasing P 0 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 ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD All rights reserved. *****"**IMPORTANT NOTICE EFFECTIVE 1/1/12******** TO CERTIFICATE HOLDER We want to share with you some important information regarding certificates of insurance. The Texas Legislature passed and Governor Perry signed Senate Bill 425 to become effective January 1, 2012. This law will require certificate of insurance forms to be filed with and approved by the Texas Department of Insurance before they can be used after the effective date of the law. In addition, the law explains current Texas Department of Insurance rules that a certificate of insurance must not obscure or misrepresent the coverage provided by the insurance policies. Definition of "Certificate" includes checklists, affirmations and electronic forms. After January 1, a certificate holder who requires an agent or policyholder to use an unapproved form or insert inappropriate language on a certificate may be sued by the Attorney General for injunctive relief or to recover a civil penalty of up to $1,000 for each such requirement. An insurance agency could incur significant penalties of up to $1,000 for each violation under those rules and the new law, including the revocation of the agency's insurance license, if a certificate were issued exactly as the certificate holder requested. For this reason, after 1/1/12 we will issue the standard certificate of insurance form and may not be able to comply with some of the items you request. Certificate holders can mail certificate forms and special wording requests for approval to: P&C Intake Unit Texas Department of Insurance 333 Guadalupe Austin, TX 78701 commercialpc(abtdi.state.tx.us Please contact us with any questions you may have. N11113,r Inc. 8144 Walnut Hill Lane, 16th 11nor Dallas, Texas 75231 972-770-1600