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HomeMy WebLinkAboutR A SMITH NATIONAL INC - INSURANCE CERTIFICATERASMITH-01 CTHOMPSON ,acoRO" CERTIFICATE OF LIABILITY INSURANCE `� DATE'2/20/YYYY) 7/z/zo1 a 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 Johnson Insurance Milwaukee 555 Main Street Ste 291 Racine, WI 53403 CONTACT NAME: PHONE 800 509-4547 F"" AD,No`at):1 ) ac No: (877) 254-8586 E-MAIL - ADDRESS: INSURERS) AFFORDING COVERAGE NAICY INSURER A: RLI Insurance Group 113056 INSURED INSURER B : INSURER C: R.A. Smith National, Inc. Chris Pinkowski 16745 W. Bluemound Rd, Ste 200 INSURER 0: INSURER E: Brookfield, WI 530055938 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 CONTRACTOR 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 LTR TYPE OF INSURANCE 'Db S POLICY NUMBER POLICY EFF MM/DDIYYri POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X PSB000325807/01/2014 07I01I2015 EACH OCCURRENCE $ 1,000,00 pREMISEs Eaoccurrence $ 1,000,00 MED EXP (Any one person) S 10,000 PERSONAL BADVINJURY $ 1,000,00 GENT AGGREGATE LIMIT APPLIES PER: PR - POLICY FX] JECT 0 LOC GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMPIOP AGO $ 2,000,00 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,00 X BODILY INJURY (Per person) $ A ANY AUTO PSA0001190 07/01/2014 07/01/2015 OWNEDALL AUTOS AUTOSCHEDULED BODILY INJURY (Per accident) $ X HIRED AUTOS AUTO-0WNEO N aaccide PERTYDAMAGE (Per tJ $ 8 X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,00 AGGREGATE $ A EXCESS LIAO CLAIMB-MADE PSE0003043 07/01/2014 07/01/2015 OED RETENTION$ $ 5,000,00 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? N/A PSW0002015 '07/01/2014 07/0112015 PER OTH- STATUTE _� ER E.L. EACH ACCIDENT $ 1,000,00 E. L. DISEASE -EA EMPLOYE $ 1,000,00 (t ies,doryin andNHH Dyes,RINOe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,00 A Professional Liabili RDPOO11233 07/01/2014 0710112015 1 Per Claim 2,000,00 A Professional Liabili RDPOO11233 07I01I2014 07/0112015 Aggregate 2,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES )ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) The City of Fort Collins Colorado and The Larimer County Canal No. 2Irrigation Company are additional insured The City of Fort Collins 300 LaPorte Ave. Fort Collins, CO 80521 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 (2014101) © 1988-2014 J The ACORD name and logo are registered marks of ACORD All rights reserved