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HomeMy WebLinkAboutBACKFLOW SOLUTIONS INC - INSURANCE CERTIFICATEA� " CERTIFICATE OF LIABILITY INSURANCE TE OAl2/3 /2014) 12/31/2019 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 endonsement(s). PRODUCER DSP Insurance Services, Inc. 1900 E. Golf Road CONTACT NAME: J Stephen Pohl PHONE (847) 934-6100 X No:(847) 934-6186 E-MAIL ADORES: Suite 650 Schaumburg IL 60173 INSURERS AFFORDING COVERAGE NAIC Is INSURERA:Valley Forge Insurance Co. 20508 INSURED (708) 389-5600 Backflow Solutions, Inc. INSURER B: Technology Insurance Company 42376 INSURER C: Admiral Insurance Co. 24856 INSURER D: 12607 S. Laramie Ave. INSURER E: Alsip IL 60803 INSURER F: COVERAGES CERTIFICATE NUMBER: Cart ID 15450 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 ADDL i= SUBR POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY UP MMIDO LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 CLAIMS -MADE �% OCCUR 6016191751 1/1/2015 1/1/2016 PREMISES fEa ocau ence $ 500,000 X MED UP (Any we person) $ 15,000 Contractual Liab PERSONAL S ADV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO. POLICY [X] �LOC PRODUCTS-COMP/OP AGG $ 2, 000, 000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acddanl $ 1,000,000 X BODILY INJURY (Per person) $ A ANY AUTO 6016191801 1/1/2015 1/l/2016 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X NON MED HIRED AUTOS X AUTOS PROPERTYDAMAGE Per accident)$ $ A X UMBRELLA UAB X I OCCUR 6016191796 1/1/2015 1/1/2016 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMSWADE DED I I RETENTION$ $ B ORKERS COMPENSATION WT AND EMPLOYERS LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? � NIA TWC3305722 1/1/2015 1/1/2016 X I STATUTE I I ER E.L. EACH ACCIDENT $ 1,000,000 EL. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) I/ yes, describe under DE ins,OF OPERATIONS below EL.DISEASE -POLICY LIMIT $ 11000,000 C PROF/POLL LIBIL AITY 3494003 1/1/2015 1/1/2016 Each Claim/ S 2,000,000 Aggregate $ DESCRIPTION OF OPERATIONS LOCATIONS VEHICLES (ACORD 101, AddRlonal Remarks Schedule, may D anached If mom space Is required) City of Fort Collins is added as Additional Insured with respect to General Liability and Automobile Liability as required by written contract. City of Fort Collins Attn: Norman Mill 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 ©1988-2013 ACORD ACORD 25 (2013/04) The ACORD name and logo are registered marks of ACORD n--- , -. ,