HomeMy WebLinkAboutCOUPER ELECTRIC LLC - INSURANCE CERTIFICATE (4)AcoROV CERTIFICATE OF LIABILITY INSURANCE DATE(MM;DD'YYYY)
9/27/2018
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 CONTACT
NAME_ _._RM LOnkTont
TrueNorth Companies, L.C. PHONE --- FAX
500 1 st St SE A; x • 303-776-5122 c No):
Cedar Rapids IA 52401 A MAILS , certs@truenorthcompanies.com
INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA Pinnacol Assurance Company 41190
INSURED
Couper Electric LLC
1331 Kanemoto Lane
Erie CO 80516-6947
COUPC_L-01
INSURER
INSURER
COVERAGES CERTIFICATE NUMBER:10689nA364 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.
I�TR TYPE OF INSURANCE I POLICY NUMBER MMDD YYFF�MMiDD YYP LIMITS
COMMERCIAL GENERAL LIABILITY
( 1 OCCUR
CLAIMS -MADE u
EACH OCCURRENCE _
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$ _
! $
MED EXP (Any one son
$
PERSONAL 3 ADV INJURY
$
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$
POLICY jE LOC
PRODUCTS - COMP!OP AGG
$
$ ---
OTHER'
AUTOMOBILE LIABILITY
_
COMBINED SINGLE LIMIT
Ea accident) __
$
'
BODILY INJURY (Per person)
! $
ANY AUTO
OWNEDONLY AUTOS SCHEDULED
AUTOS
---
BODILY INJURY (Per accident)
—
` $
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTFbAMAGE
P raccident
$
$
UMBRELLA LIAB OCCUR
EACH OCCURRENCE
$
EXCESS LLIIAB— j CLAIMS -MADE
AGGREGATE
$
$
DED I RETENTION
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITYUTE
YIN
'ANYPROPRIETOR/PARTNER.'EXECIJTIVE
OFFICERiMEMBEREXCLUDED' N
NIA
�089007
10l2018
11/112019
PEAR
$TTiEIR
—�_--
$1.000,000,____._..,__.,..._.,_.._
E.LEACHACCIDENT F�
(Mandatory In NH)
E.L. DISEASE - EA EMPLOYEE
$1,000,000
If Yes. describe under
DESCRIPTION OF OPERATIONS below
_ _-_--
$ 1.000,000
E.L. DISEASE - POLICY LIMIT'
I
DESCRIPTION OF OPERATIONS! LOCATIONS VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
[y7:111111BNlG\IMiLei ,aJa:1
City of Fort Collins
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
C) 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD