HomeMy WebLinkAbout350732 STURGEON ELECTRIC COMPANY INC - INSURANCE CERTIFICATEAl 7:/l
(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 4/2018
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 have ADDITIONAL INSURED provisions or 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 CONTANAME: CT Shannon Lentz
Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX
2850 Golf Road aS c. No> Ext): 630-285-4418 _ A/c No): 630-285-3922
Rolling Meadows IL 60008 ADDRESS: shannon_lentz(Majg.com
INSURED MYRGROU-01
Sturgeon Electric Company, Inc.
12150 E. 112th Avenue
Henderson, CO 80640
INSURERS) AFFORDING COVERAGE NAIC #
A: Zurich American Insurance Company 16535
B : National Fire & Marine Insurance Co 20079
c : American Zurich Insurance Company 40142
D:
F:
CnVFRAnFS CFRTIFICATE NIIM1RER-13gR1gh11q 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.
R
LTR
TYPE OF INSURANCE
-OUWBILT
R
POLICY NUMBER
MOLIC/YYYF
LI D/YYYY
M
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE 1K OCCUR
GLOB37415424
9/30/2018
9/30/2019
EACH OCCURRENCE
$ 2,000,000
DAMAGE TO RENTED
ccurrence
PREMISES Ea occurrence)
$100.000
MED EXP (Any one person)
$10,000
PERSONAL & ADV INJURY
$ 2.000,0()0
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY F7 PO -
JET LOC
OTHER:
GENERAL AGGREGATE
$ 4,000,000
PRODUCTS - COMP/OP AGG
$ 4,000,000
$
A
AUTOMOBILE LIABILITY
X ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
BAP837415522
9/30/2018
9/30/2019 COMBINED SINGLE LIMIT
Ea accident
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE
1Per accident}
Come Ded $100,000
$ 2,000,0100
$
$
$
$ Coll Ded$100,000
B
X
UMBRELLA LIAR
EXCESS LIAR
X
OCCUR
CLAIMS -MADE
42UM030293703
9/30/2018
W30/2019
EACH OCCURRENCE
$10,000,000
AGGREGATE
$10,000,000
DIED I X RETENTION
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANYPROPRIETOR/PARTNER/EXECUTIVE a
OFFICER/MEMBEREXCLUDED?
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
WC837415222(A/O/S)
WC837415322(MAAM)
9/30I2018
9/30/2018
9/30/2019
9/30/2019
X PER—TH_
ER
E.L. EACH ACCIDENT
— -
$1,000,000
E.L. DISEASE - EA EMPLOYEE
$1,000,000
E.L. DISEASE- POLICY LIMIT
$ 1,000,000
li
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Description of Job: Contractor's License
City of Fort Collins, Colorado is shown as an additional insured solely with respect to general liability and automobile liability coverage as evidenced herein as
required by written contract.
f1CC2TICICATC urll 111=0 r-ANCFI I ATInN
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Fort Collins, Colorado
ACCORDANCE WITH THE POLICY PROVISIONS.
281 N. College Avenue
AUTHORIZEDREPRESENTATIVE
Ft. Collins CO 80524
USA
U 1881:5-2U15 ACUHU cUHF'UIiAI IUN. All rlgntS reserveo.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD