HomeMy WebLinkAboutFISKE INC DBA FISKE ELECTRIC - INSURANCE CERTIFICATE (5)A ^ ^ n®
lV("J'RLJ CERTIFICATE OF LIABILITY INSURANCE
DATE (/Y)
1v08o8r20182o1s
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 Kylie Carey, CISR, CIC
NAME:
Flood and Peterson
PNCNN Ext : (970) 266-7148 FAX
No): (970) 506-6845
E-MAIL KCarey@floodpeterson.com
ADDRESS:
PO Box 578
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURERA: Employers Mutual Casualty Company
21415
Greeley CO 80632
INSURED
INSURER B : Plnnacol Assurance
41190
INSURER C :
Fiske, Inc., DBA: Fiske Electric
INSURER D :
6766 E. County Road 18
INSURER E :
INSURER F :
Johnstown CO 80534
COVERAGES CERTIFICATE NUMBER: CL1811826099 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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.
ILTR
TYPE OF INSURANCE
IN
WVD
POLICY NUMBER
MMIDDY/YYYY
MMl D//YYW
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE � OCCUR
RENTEDDAMAGE TO
PREMISES Ea occurrence
$ 500,000
MED EXP (Any one person)
$ 10,000
A
5D95845
11/15/2018
11/15/2019
PERSONAL & AOV INJURY
$ 1,000,000
GEN'LAGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
PRO -
POLICY LOC
�
OTHER:
Limited Pollution Llablllt
$ 1,000,000
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
BODILY INJURY (Per person)
$
X ANYAUTO
BODILY INJURY (Per accident)
$
A
OWNED X SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
X AUTOS ONLY X AUTOS ONLY
5E95845
11/15/2018
11/15/2019
PROPERTY DAMAGE
Per accident
$
Uninsured motorist
$ 1,000,000
X
UMBRELLA
X
OCCUR
vV"76F( V,,'?N'_C ,,,,•
EACH OCCURRENCE
$ 3,000,000
A
EXCESS LIAB
CLAIMS -MADE
5J95845
11/15/2018
11/15/2019
AGGREGATE
$ 3,000,000
DED X RETENTION $ 0
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY v I N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
NIA
4066524
03/01/2018
03/01 /2019
X STATUTE ERPER H
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__7.
Leased/Rented Equipment
FA
F5C95845
11/15/2018
11/15/2019
$100,000 Limit
$1,000 Deductible
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
I,AM,.CLLN1 IUN
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 n
Fort Collins CO 80522 ® /)
U 1988-2015 AGURD GURPURAI IUN. All rights reservea.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD