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HANNA ELECTRICAL CONTRACTING INC - INSURANCE CERTIFICATE (2)
® A� L7 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 10/18/2018 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 CONTACTBrianne Danielson, CISR Flood and Peterson (PAHONE (g70) 266-7118 F IX (970) 506-6846 !C No Ext : A/C, No): E-MAIL s: BDanielson@FloodPeterson.com ADDRE Corporate Mailing Address: INSURER(S) AFFORDING COVERAGE NAIC # P.O. Box 578 INSURER A : Tri-State Insurance Company of Minnesota 31003 Greeley CO 80632 INSURED INSURER B : Firemen's Insurance Company of Washington D.C. 21784 Hanna Electrical Contracting, Inc. INSURER C : Pinnacol Assurance 41190 INSURER D : 1614 Harris Drive INSURER E : INSURER F : Fort Collins CO 80524 rnVFRAnFS CERTIFICATE NLJMRER: CL18101825601 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. INPOLICY TR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM DDYlYYYY EXP MMDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE I —XI OCCUR PREMISES Ea occurrence $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL s ADV INJURY $ 1,000,000 A ADV3183302-21 11/01/2018 11/01/2019 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO El LOC JECT PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Pe raccident) $ B OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY CPA3183303-21 11/01/2018 11/01/2019 PROPERTY DAMAGE Per accident $ Unins. Mot. Liability $ 1,000,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LIAB CLAIMS -MADE CPA3183303-21 11/01/2018 11/01/2019 AGGREGATE $ 1,000,000 DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY v / N ANYPROPRIMBER/PXCLUDE/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA 4205758 11/01/2018 11/01/2019 PER OTH- X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) City of Fort Collinsis included as Additional Insured as required by written contract with respects to liability arising out of work performed by the named insured. L;hK 1 IFK:A I t HULLIt_K k ANL r_LLA I IVIY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 580 AUTHORIZED REPRESENTATIVE Fort Collins CO 80522 eaQ/I w I0411idw, ©1988-2015 ACORD CORPORATION. All ngnts reservea. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD