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SIMPSON ELECTRIC INC - INSURANCE CERTIFICATE (10)
-� SIMPELE-01 MMATHEWS ,a►�oRO CERTIFICATE OF LIABILITY INSURANCE oarE 1 31312015vr) 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 NUN" " Dale Floyd PHONE FAX ac No. Exi : (303) 776-5122 A C No): (303) 776-5495 ADDRESS: INSURERS) AFFORDING COVERAGE NAIC 0 INSURER A; Charter Oak Fire Insurance Company 25615 INSURED Simpson Electric, Inc 1920 Glenview Court Berthoud, CO 80513 INSURER B: Owners Insurance Company 32700 INSURER C: Travelers Indemnity Company 25658 INSURER D: Pinnacol Assurance Company INSURER E : INSURER F : 41190 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. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYV LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR i6803299C359 02I20I2015 02/20/2016 EACH OCCURRENCE $ 1,000,00 DAMAGE TO R` PREMISES Ea000unence $ 300,00 MED EXP (Any one person) $ 5,00 PERSONAL B ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PE� LOC OTHER: GENERAL AGGREGATE $ 2,000,00 PRODUCTS TS-COMP/OP AGO $ 2,000,00 $ B AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED X AUTOS AUTOS X NON -OWNED HIREDAUTOS AUTOS 268566900 11/24/2014 11/24/2016 COMBINED SINGLE LIMIT Ea aceidern $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Par accidem $ C X UMBRELLA LIAR EXCESS LIAR X OCCUR CLAIMS -MADE CUP812GC161 02I20/2015 02/20/2016 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 DED I X I RETENTION $ 5,000 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes describe under DESCRIPTION OF OPERATIONS below NIA 1495820 04/01/2015 0410112016 STAME ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE -EAEMPLOYEE $ 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 ace is required) ( Y P q ) City of Fort Collins as Additional insured with respect to General Liability per policy form CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins Attn: Laurie THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD