HomeMy WebLinkAboutCOUPER ELECTRIC LLC - INSURANCE CERTIFICATE (2)�'� �® CERTIFICATE OF LIABILITY INSURANCE
DATE
10/9/2013 '
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
First Mainstreet Insurance, LLC
275 S. Main Street, Suite 100
P.O. BOX 847
Longmont CO 80502
CONTACT Michelle Tusinski
NAME:
PHONE (3O3) 776-5122 IAC No: (303)776-5495
- IL
EMAESS
INSURERS AFFORDING COVERAGE
NAIC9
INSURERAAuto Owners Insurance Co.
18988
INSURED
Couper Electric LLC
1331 Kanemoto Lane
Erie CO 80516-6947
INSURERB:OWners Insurance Company
INSURER C:Pinnacol Assurance
INSURER D:
INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBER:13-14 Master 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 VVITH 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
POLICY NUMBER
POLICY EFF
MMIDDIYYYI'
POLICY E%P
MMID ry YY
LIMITS
A
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE DOCCUR
74068759
10/1/2013
10/1/2014
EACH OCCURRENCE
$ 1,000,000
PREMISES fEa occurrence
$ 300,000
MED EXP(Any one person)
$ 10,000
PERSONAL B ADV INJURY
,000
$@2,000,000
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER.
JECT
X POLICY PRO LOC$AUTOMOBILE
PRODUCTS-COMPIOP AGG
$,000
B
LIABILITY
X ANYAUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
X HIRED AUTOS N AUTOS
19
851218300
0/1/2013
10/1/2014
Ee arcid N) NGLE LIMIT
000
BODILY INJURY (Per person)
$
BODILY INJURY (Per acaden0
$
PROPERTY DAMAGE
Per eccitlent
$
Road Trcuble Service
$ 75
UMBRELLA LIAR
EXCESS LIAB
OCCUR
CLAIMS MADE
I
EACH OCCURRENCE
$
AGGREGATE
$
DED I I RETENTION$
I
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNERIEXECUTIVE �
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If y describe under
DE SCRIPTION OF OPERATIONS DeIow
N/A
089007
10/'_/2013
10,11/2014
WC $TATdU OTH-
11
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYE
$ 1,000,000
E.L. DISEASE -POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Ranarics Schedule, If more space in required)
City of Fort Collins
PO 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
Tusinski/MTUS Iy ` 1 t)uc r"1 K%I--
ACORD 25
01988-2010 ACORD CORPORATION. All rights reserved.
INS025 (201005).01 The ACORD name and logo are registered marks of ACORD