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HomeMy WebLinkAboutSIMPSON ELECTRIC INC - INSURANCE CERTIFICATE (9)SIMPELE-01 CEVIG ALVKU CERTIFICATE OF LIABILITY INSURANCE 1 DATDIYYYY) 2/25/22512015 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 endorsement(s). PRODUCER TrueNorth PO Box 847 Longmont, CO 80502 INSURED Simpson Electric, Inc 1920 Glenview Court Berthoud, CO 80513 NAME: I Dale Floyd _ PHONE Fnrc N ac No.Est,: (303 776-5122 d; 303 776,495 ADDAIL RESS: INSURE S AFFORDING COVERAGE NAIL N INSURER A: Charter Oak Fire Insurance Company 25615 INSURER B: Owners Insurance Company 32700 INSURER C: Travelers Indemnity Company 25658 INSURER D: Pinnacol Assurance Company 41190 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. ILPOLICY EXP TR TYPE OF INSURANCE POLICY NUMBER POLICY EFF MM DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS4dADE O OCCUR 6803299C359 02I20/2015 02/20/2016 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence S 300,00 MED EXP (Any one person) $ 5,00 PERSONAL BADVINJURY $ 1,000,00 GEML AGGREGATE LIMIT APPLIES PER: X POLICY 7 j 07 LOC OTHER GENERAL AGGREGATE $ 2,000,00 PRODUCTS-COMP/OP AGG $ 2,000,00 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X NON -OWNED HIRED AUTOS AUTOS 4268565900 11/24/2014 11/24/2015 COMBINEDSINGLE LIMIT $ 1,000,0 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ S C X UMBRELLA UAB EXCESS LIAB X OCCUR CLAIMS -MADE CUP8126C161 1 02/20/2015 02/2012016 1 EACH OCCURRENCE $ 1,00(),000 AGGREGATE $ 1,000,00 DIED I X RETENTION $ 5,000 $ WORKERS COMPENSATIONIA AND EMPLOYERS' LBILITY D ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICERWEMBER EXCLUDED? ❑ (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below NIA �1495820 04/01/2014 04/01/2015 PER OTH- STATUTE ER E.L. EACH ACCIDENT S 1,000,00 E.L. DISEASE -EA EMPLOYE $ 1,000,00 E.L. DISEASE -POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) IrCR r iril, I C r1VLUCr[ City of Fort Collins Attn: Laurie P.O. 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 &*L- 000" © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD