HomeMy WebLinkAboutTEAM ELECTRIC INC - INSURANCE CERTIFICATE (5)ACO/ZO®
`� CERTIFICATE OF LIABILITY INSURANCE
DATE I"DUDD'YYY'n
I 01272D15
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 endorsements .
PRODUCER
FEDERATED MUTUAL INSURANCE COMPANY
HOME OFFICE: P.O. BOX 328
CONTACT CONTACTCLIENI CENTER
IIAME�
AIC, Mo.E%<: 888-333-4949
FJLAIC No): 507-446-4664
E-MAIL
ADDRESS: CLIENTCONTACTCENTER FEDINS.COM
OWATONNA, MN 55060
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A: FEDERATED MUTUAL INSURANCE COMPANY
13935
INSURED 355-776-6
INSURER B:
TEAM ELECTRIC INC
INSURER C:
1158 S LIPAN ST
INSURER D:
DENVER, CO 80223
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 21 REVISION NUMBER: 0
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
DL
INS
SUER
WVD
POUCY NUMBER
POUCY EFF
MMIDDIYYYY
POUCY EXP
MMIDDIYYYY
UMITS
GENERAL LIABILITY
EACH OCCURRENCE
$1,000,000
X COMMERCIAL GENERAL LIABIUTY
DAMAGE TO RENTED
P EMIS S o IDentt
$100,000
CLAIMS -MADE X OCCUR
one p
MED EXP (Myerson)
$5,000
PERSONAL& ADV INJURY
$1,000,000
A
N
N
9030550
03/01/2015
03/01/2016
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE
OMIT APPLIES
PER:
PRODUCTS-COMPIOP AGO
$2,000,000
X POUCY
PRI
JECT
LOG
AUTOMOBILE
X
LIABILITY
ANY AUTO
COMBINED SINGLE UNIT
den
$1,000,000
BODILY INJURY (Per person)
A
ALL OWNED SCHEDULED
AUTOS AUTOS
N
N
9030550
03/01/2015
03/01/2016
BODILY INJURY (Per accident
HIRED AUTOS NON -OWNED
AUTOS
PROPER,YAM TDAGE
a
X
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE
$5,000,000
A
EXCESS LIAB
CLAIMS -MADE
N
N
9030551
03/01/2015
03/01/2016
AGGREGATE
$5,000,000
DED RETENTION
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY T. I N
ANY PROPRIETOR/PARTNERIEXECUTIVE
X WC STATU-
TORY UMITS
OTH-
ER
E.L EACH ACCIDENT
$500 000
A
OFFICER/MEMBER E%CLUDED?
NIA
N
9030553
03/01/2015
03/01/2016
E.L DISEASE - EA EMPLOYEE
$500,000
(MaMatory in NH)
U yea, describe under
DESCRIPTION OF OPERATIONS below
E.1- DISEASE - POUCY UMIT
$500 000
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Amen ACORD lot. Addidonal Remarks SU,edule, it more space is required)
355-776-6
CITY OF FORT COLLINS
PO BOX 580
FORT COLLINS, CO 80522-0580
21 0
LHNLCLLA I I W N
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
O 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD