HomeMy WebLinkAbout489486 TUV RHEINLAND - INSURANCE CERTIFICATE (2)TUVRHEI-03 LTELLER
CERTIFICATE OF LIABILITY INSURANCE
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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 endomement(s).
PRODUCER
Rose & Kiernan, Inc.
Lee Farm Corporate Park
83 Wooster Heights -
Danbury, CT 06810
CON
NAME:
FAX
PHONE (203) 702-4700 LAIC, N°: (203) 702-4759
A/c "O Ei1 i
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC#
INSURER A:Allianz Global Risks US Insurance Company
35300
INSURED
TUV Rheinland North America Holding, Inc.
1300 Massachusetts Ave Ste 103
Boxboroug h, MA 01719
INSURER B: Travelers Property Casualty Company of America
25674
INSURER C:
INSURER D:
INSURER E:
INSURER F :
COVERAGES CERTIFICATE NUMBER: 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.
LTR
TYPE OFINSURANCE
ADDLSUBH
POLICY NUMBER
MM/DDNYYY
MMID ?DI YYY
LIMITS
A
X
COMMERCIALGENERALLIABILITY
EACH OCCURRENCE
$ 1,000,00
CLAIMS -MADE T OCCUR
CGL 2005473
0110112015
0110112016
PREMISES (Earrencej
$ 100,00
MED EXP (Any one person)
$ 10,000
PERSONAL B ADV INJURY
$ 1,000,00
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,00
X POLICY PRO-
ECT ❑ LOC
PRODUCTS - COMP/OP AGO
$ 2,000,00
$
OTHER'
AUTOMOBILE LIABILITY
OMB aernSINGLE
$ 1,000,00
B
X ANY AUTO
P8103343P614TIL15
01/0112015
0110112016
BODILY INJURY (Per person)
$
ALL MANED SCHEDULED
AUTOS AUTOS
HIRED AUTOS AUUTOS N-OMEU-
BODILY INJURY (Per acddent)
$
Per aaden DAMA
$
$
X
UMBRELLA UAB
X
OCCUR
EACH OCCURRENCE
$ 4,000,00
AGGREGATE
$ 4,000,00
A
EXCESS LIAB
CLAIMS -MADE
ULA 2005474
0110112015
0110112016
LIED
I X
I RETENTION$ 330,000
1 $
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORRARTNERIEXECUTIVE YIN
OFFICERIMEMBER EXCLUDED?
(Mammary in NH)
N/A
PJUB328OPS0615
01/0112015
01101/2016
X I STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,00
E.L. DISEASE - EA EMPLOYIEE
$ 1,000,00
1( yes, descnbe under
DESCRIPTION OF OPERATIONS below
E.I.. DISEASE - POLICY LIMIT
$ 1,000,00
A
Professional Liabili
CG 2006475
0110112015
01101/2016
Occurrence/Aggregate 5,000,00
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Sclmdule, may 1» attached if more space is required)
Project: 7218 ISO 14001 Audit Services The City of Fort Collins, its officers and employees as an additional insured with respect to General Liability but only
as required by written contractiagreement.
CERTIFICATE HOLDER CANCELLATION
The City of Fort Collins
Purchasing Division
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
(�{,'-H �-
1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD