HomeMy WebLinkAbout494376 ATLAS INDUSTRIAL HOLDINGS LLC - INSURANCE CERTIFICATE (2)c 1 CERTIFICATE OF LIABILITY INSURANCE
N...r1
DATE(MMIDDI
02126/2013
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 endorsement(s).
PRODUCER
CO"TACT Teresa Haak
Franchise Insurance Agency, Inc.
PHONE . 614 545.1538 FAx .(855) 720-4940
4942 Reed Road
E-MAIL . Teresa@franchise-ins.com
INSURERS AFFORDING VERAGE
NAIC If
Columbus, OH 43220.6105
ER . Hartford Fire Insurance Company
19682
OL�-
INSURED
INSURER B. Twin City Fire Insurance Company
29459
INSURER C St Paul Fire & Marine Insurance Company
24767
Atlas Industrial Holdings, LLC.; Atlas Industrial Contractors, LLC.
INSURER D Travelers Property Casualty Insurance Company
36161
5275 Sinclair Road
INSURER E
Columbus, OH 43229-5042
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
TYPE OF INSURANCE
ADD
SUBR
Y NUMB
POLICY EFF
POLICY E%P ryyyyi
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$1,000,000
DAMAGETORENTED
$300,000
A
% COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE 51 OCCUR
x
x
33UENOH0218
03101/2013
03/01/2014
MED EXP (Any one erson
$10,000
PERSONAL B ADV INJURY
$1,000,000
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE
LIMIT APPLIES
PER:
PRODUCTS - COMPIOP AGG
$2,000,000
$
POLICY
X PRO
LOC
COMBINED SINGLE LIMITA
BODILY INJURY(Per person)
$
ANY AUTO
BODILY INJURY(Per accident)
$
POMOBILELIABLITY
ALL OWNED SCHEDULED
HRTEDSCIS
AUTOS % NON -OWNED
AUTOS
X
X
33UENOH0219
03/01/2013
03101/2014
PROPERTY DAMAGE
$
$
X
UMBRELLA LIAR
OCCUR
EACH OCCURRENCE
$ 5,000,000
N
AGGREGATE
$5,000,000
G
EXCESS LIAB
CLAIMS"MADE
X
X
ZUP-14R85493-13-NF
0310112013
03101/2014
OED I I RETENTION
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILIN
OFFICER/ EIMBEER EXCLUDED EGUTN�
(Mandatory In NH)
NIA
x
33WEOH0217
03101/2013
03/01/2014
X WC STATU- OTH-
EL EACH ACCIDENT
$1.000.000
E. L. DISEASE - EA EMPLOYEE
$1,000,000
If as, describe under
DE RIPT10 OF OPE TI N elow
E.L. DISEASE -POLICY LIMIT
$1,000,000
Riggers Liablity &
D
Installation Floater
x
x
QT SA046649-COF13
03/01/2013
03101/2014
Limit Per Location" $5,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ANach ACORD 101, Additional Remarks Schedule, If more space Is required)
Leased/Rented Equipment-$1,500,000; $5,000 Deductible subject to policy terms, conditions & exclusions. Coverage is provided for boom &jib overload.
Ohio Stop Gap Policy 33UENOH0218 $1,000,000; $1,000,000; $1,000,000 - Excess Workers' Com ensation listed above, Policy 33WEOH0217
City of Fort C011ins
215 North Mason Street 2nd Floor
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 REPRESENTATIV �. n
1
reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD