HomeMy WebLinkAboutFORD AUDIO-VIDEO - INSURANCE CERTIFICATEACORO® CERTIFICATE OF LIABILITY INSURANCE
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DATE 2014YY)
12/30/2014
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(!") 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
Willie of Oklahoma, Inc.
CONTACT
NAME:
PHONE 1 FA%
46]-23]8
c/o 26 Century Blvd
EJMR
ADDRESS: cartiEicetaserillis. com
P.O. Bour305191
e, TN 372305191 USA
Nashville,
INSURERS AFFORDING COVE GE
NAIC N
INSURERA:Valley Forge Insurance Company
20508
INSUREDFord Audio -Video Syatams, LLC
INSURER B:Continental Insurance Company
35289
INSURER C:Continental Casualty Cornpany
20443
4800 West Interstate 40
Oklahoma City, OK 731285425'
INSURER 0:
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER:W]0644] 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
R
TYPE OF INSURANCE
ADDL
SUER
pODCY NUMBER
EFF
MA01IUDDY
MOUCYEX MfoDP
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 11000,000
CLAIMS -MADE [] OCCUR
T RENTED
DAMA E PREMISES ance
$ 300,000
MED EXP (Any one parson)
$ 10,000
A
PERSONAL B ADV INJURY
$ 11000,000
6016746553
12/31/2014
12/31/2015
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
S 2,000,000
POLICY lJECOT �LOC
PRODUCTS - COMPIOP AGG
$ 2,000,000
$
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Es accident
$ 11000,000
X
BODILY INJURY(Par Person)
$
ANY AUTO
B
ALL OWNED SCHEDULED
AUTOS AUTOS
6016746522
12/31/2014
12/31/2015
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
NON -OWNED
HIREDAUTOS AUTOS
$
C
X
UMBRELLA LAB
X
OCCUR
EACH OCCURRENCE
$ 10, 000, 000
AGGREGATE
$ 10,000,000
EXCESS LAB
I CLAIMS -MADE
6016746519
12/31/2014
12/31/2015
DIED I X I RETENTION$10 000
$
1
A
WORKERS
WORKERS COMPENSATION
ANY PROPRIETOR/PARTNER/EXECUTIVE Y f N
OFFICER?4EMBER EXCLUDED]
NIA
6016746536
12/31/2014
-
12/31/2015
X STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 11000,000
(Mandatory in NH)
If yes describe under
DESCRIPTION OF OPERATIONS below
EL.DISEASE - POLICY LIMIT
$ 11 000, 000
C
Instellaion Floater
IN6016405878
12/31/2014
12/31/2025
$5,000,000
Subject to $2,500 deductible
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLE$ (ACORD 1011.Addidorel Rensuss Schedule, ma be aflached It more space Is required)
ord AV Job #1104361 - ne City, its officers, agents d employees are additional insureds in regards to the Lincoln Center Canyon West Audio/Video
roject.
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
City of Fort Collins
PO Boz 580
Fort Collins, CO 80522-0000
TION. All rieht5 reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
SR ID:8071349 BATCH:Batch W: 1D3237