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HomeMy WebLinkAboutENGINEERED STRUCTURES INC - INSURANCE CERTIFICATE7e/28/2018 TE (MM/DD/YYYY) A� " CERTIFICATE OF LIABILITY INSURANCE 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 CONTACT M. Naomi Plumley umey The Leavitt Group of Boise, Inc. PHONE x (208)375-9199 FAX No: (208)658-1951 6220 N. Discovery Way, Ste 100 ADDRESS:naomi-plumley@leavitt.com INSURER(S) AFFORDING COVERAGE NAIC 0 Boise ID 83713 INSURERA:National Union Fire Insurance 019445 INSURED INSURERB:Travelers Property Casualty Company 25674 Engineered Structures, Inc. INSURERC:New Hampshire Insurance Company 23841 3330 E. Louise Drive INSURER 0: Suite 300 INSURERE: Meridian ID 83642 INSURERF: rnVFRAI;FS CFRTIFICATF NIIMRFR-18-19 Master REVISION NUMRFR- 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 LTRWVp TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMIDDPOLIEFF POLIC MM/DDY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE CJ OCCUR DAMAGE 10 RENTED PREMISESE.occurrence) $ _ 300,000 MED EXP (Any one person) GL3292147 9/1/2018 9/1/2019 $ 10,000 PERSONAL & ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY Fyl I PEA LOC PRODUCTS - COMP/OPAGG $ 2,000,000 Employee Benefits $ 1,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ $ A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS AL4544799 9/1/2018 9/1/2019 BODILY INJURY (Per accident) X PROPERTY DAMAGE Per accident)$ NON -OWNED HIRED AUTOS X AUTOS $ X X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 20, 000, 000 X AGGREGATE $ 20, 000, 000 B EXCESS LIAB CLAIMS -MADE DED I X RETENTION 10,000 $ ZUP71M6429218NF 9/1/2018 9/1/2019 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN X PER OTH- STATUTE ER `, ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? 7 (Mandatory in NH) A NIA WC25893627 9/1/2018 9/1/2019 E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS belo:a E.L DISEASE - POLICY LIMIT $ 1 000,000 A California WC WC25893628 9/1/2018 9/1/2019 EL Limits$1,000,000/ LGB CA Lic #OE16971 $1,000,000/$1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RECEIVED SEP 0 5 2018 City Manager's Offia- UtK l 11-IUA I t HULUtK l,ANIL,LLLA 1 IUN samanthatallman@esiconstru City of Fort Collins 300 La Porte Ave Fort Collins, CO 80521 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 Dwayne Speegle/NAPLUM © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)