HomeMy WebLinkAboutUS POWERS INSULATION - INSURANCE CERTIFICATEACORO® CERTIFICATE OF LIABILITY INSURANCE
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DADDNYYYI
061225015/2014
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 endorsemen s .
PRODUCER
Marsh USA Inc.
333 South 7th Street, Suite 1400
CONTACT
NAME:
PHONE FAX No
E-MAIL
ADDRESS:
Minneapolis, MN 55402-2400
Attn: minneapolis.catrequest@marsh.corn 1-212.948.0114
INSURERS AFFORDING COVERAGE
NAIC 0
INSURER A: New Hampshire Insurance Company
23841
025874-Stand-GAWX-14-15 Powers
INSUREDUSI Powers InsulationINSURER
B : Lexington Insurance Company
19437
INSURER C :
2645 Durango Drive
INSURER D :
Colorado Springs, CO 80910
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: CHl W4719948-02 REVISION NUMBER:1
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
LTR
TYPEOFINSURANCE
AD L
UB
POLICYNUMBER
MMIDOYEFF
MMIDDYIYYYY
LIMITS
A
GENERALLIABILIT'
GL 538 83 24
0710112014
0710112015
EACH OCCURRENCE
$ 2,000,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE MOCCUR
DAMAGE RENTED
PREMISES RENT rtence
$ 300,000
MED UP (Any one person)
$ 5,000
PERSONAL B ADV INJURY
$ 2,000,000
GENERALAGGREGATE
$ 4,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 4,000,000
POLICY X PRO- LOC
I
$
A
AUTOMOBILE
LIABILITY
CA 5101669
07/0112014
07101/2015
COMBINED SINGLE LIMIT
Ea accident
2,000,000
X
BODILY INJURY (Per Person)
$
ANY AUTO
X
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident)
$
X
PROPERTYDAMAGE
Per accident
$
NON -OWNED
HIRED AUTOS M AUTOS.
B
X
UMBRELLA LIAR
X
OCCUR
006761832
07/0112014
07/01/2015
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 5,000,066
EXCESS LIAB
CLAIMS -MADE
DED I X I RETENTION$ 25,000
$
A
WORKERS COMPENSATION
WC 034 157 322 (ADS)
07/01/2014
0710112015
Xvvc STATU- oTH-
LIMITS
A
A
AND EMPLOYERS' LIABILITYDRY
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
N / A
WC 034 157 323 INC, UT)
WC 034 157 324 (AZ, GA, VA)
07I0112014
07/01/2014
07/0112015
07101/2015
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
A
If as, describe under
DESCRIPTION OF OPERATIONS Eel
WC 034157 325 (CA)
07/01/2014
07101/2015
E.L. DISEASE -POLICY LIMIT
$ 1,000,000
A
Workers Compensation
WC 034 157 326 (FL)
07101/2014
07I01/2015
SEEABOVE
A
Workers Compensation
WC 034 157 327 (NJ)
07101/2014
OV0112015
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, I1 more space Is required)
Re: Project: Ft. Collins Senior Center, 7534 Raintlee Drive, Ft. Collins, Colorado.
Certificate Holder and Ft. Collins Senior Center are included as additional insureds (except Workers' Compensation) where required by written contract. Waiver of subrogation is applicable where required by written
contract.
City of Ft. Collins
215 N. Mason SL
FL 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
of Marsh USA Inc.
Manashi Mukherjee �Kauraolu
01988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD