HomeMy WebLinkAboutPDC MIDWEST INC - INSURANCE CERTIFICATE,acorro® CERTIFICATE OF LIABILITY INSURANCE 12/12/19/2014 UDD14
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 polity, 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
R & R Insurance Services, Ino.
1581 '.E Racine Avenue
FG SOX 1610 '
Waukesha WI 53186
CONTACT Am Brennan - --
NAME: Y
PHONE (262) 9$3-7160A/C. No. FAX . (262195]-1119
E-MAIL .amy. brennan®rrins. com
INSURERS AFFORDING COVERAGE
NAIL d
INSURERA:Valle Forge Ins Co (CNA)
20508
INSURED
PDC Midwest Inc
1130 James Dr
Suite 106
Hartland WI 53029 -
INSURERS Continental Casualty (CNA)
20443
INSURER C:
INSURER O:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 15/16 Liab Cart REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
ODLSUBR
IIIIALPOLICY
NUMBER
POLICY EFF
POLICY EXP
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
S 11000,000
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE 7 OCCUR
5090651734
_
1/1/2015
/1/1016
PREMISES
cecumence$
$ - 300,000
MED EXP we on)
S- - 51000
PERSONAL B ADV INJURY
S 1,000,000
•
GENERAL AGGREGATE --
$ '2,000,000
GEN'L AGGREGATE
LIMIT APPLIES PER: -
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
POLICY
X PRO JFCT LOC
AUTOMOBILE LIABILITY
COMBINED SINGL LIMIT
Ea accident
11000,000
BODILY INJURY(Per"..)
$
BALL
JXANYAUTO
OWNED SCHEDULED
AUTOS AUTO$
HIREDAUTOS NNON-OWNED AUT S
5090651748
1/1/2015
1/1/2016
BODILY INJURY (Per accitlent)
$
(Pena ci DAMAGE
$
X
UMBRELLA LIAR
X
OCCUR
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 5, 000, 000
B
EXCESS LIAR
CLAIMS -MADE
DED X RETENTIONS 10, 00
S
5090651717
1/1/2015
/1/2016
A
WORKERSCOMPENSAnON
I X I WC STAI OTH-
AND EMPLOYERS' LIABILITY -
ANY. Pp OPR!ETOR7F RV:ERIESECUTNE YIN
OFFICER/MEMBER EXCLUDED? Ti
(Mandatory In NH)
NIA
_
_
5090651720
1/1/2015
_
1/1/2016
EL EACH ACCIDENT
'$� -500 000
E.L. DISEASE - EA EMPLOYE
$ 500,000
E.L. DISEASE -POLICY LIMIT
$ 500,000
If as, de scribe under
DESCRIPTION OF OPERATIONS below
5099442061
A
Equipment Leased, Borrowd
5090651734
1/1/2015
1/1/2016
Mar Item:$3.000 $100,000
or Rented from Others
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addlilonel Remarlo Schedule, 8 more apace Is required)
Re: License number Cl-233
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS.
281 N College Avenue
PO HOX 580 AUTHORIZED REPRESENTATIVE
Fort Collins, CO 80522
R Xalacheuer/AB361
l 25 (2010/05) C 1988-2010 ACORD CORPORATION. All rights reserved.
INS025(201005).01 The ACORD name and logo are registered marks of ACORD