HomeMy WebLinkAboutFISKE INC DBA FISKE ELECTRIC - INSURANCE CERTIFICATE (6)AClyR I a
C" CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
01/30/2019
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 K lie Carey, CISR, CIC
NAME: y y
Flood and Peterson
PHONE (970) 266-7148 F0'X (970) 506-6845
A/C N Ex : A/C No
E-MAIL KCarey@floodpeterson.com
ADDRESS:
P.O. Box 578
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A: Employers Mutual Casualty Company
21415
Greeley CO 80632
INSURED
INSURER B : Plnnacol Assurance
41190
INSURER C :
Fiske, Inc., DBA: Fiske Electric;
INSURER D :
C K Transportation, Inc.
INSURER E :
6766 E. County Road 18
INSURER F :
Johnstown CO 80534
COVERAGES CERTIFICATE NUMBER: FCLREgPOLxll/15/ REVISION NUMBER:
THIS iS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW1IACE'1B`EEN 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.
ILTR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
MMIDDIIYYYY
MM DDIYYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
7CLAIMS-MADE OCCUR
DAMAGE500,000
PREMISES Ea occurrence
$
MED EXP (Any one person)
$ 10,000
PERSONAL &ADV INJURY
$ 1,000,000
A
5D95845
11/15/2018
11/15/2019
GEN'LAGGREGATE LIMITAPPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
POLICY ❑X JECTPRO ❑ LOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
Limited Pollution Llabilit
$ 1,000,000
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
BODILY INJURY (Per person)
$
X ANYAUTO
A
OWNED SCHEDULED
AUTOS ONLY X AUTOS
5E95845
11/15/2018
11/15/2019
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
HIRED �/ NON -OWNED
X AUTOS ONLY /� AUTOS ONLY
Uninsured motorist
$ 1,000,000
X
UMBRELLA LIAB
X
OCCUR
V�"'v"'vV ""'y"""""
EACH OCCURRENCE
$ 3,000,000
AGGREGATE
$ 3,000,000
A
EXCESS LIAB
CLAIMS -MADE
5J95845
11/15/2018
11/15/2019
DED I X1 RETENTION $ 0
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUDED? FNJ
(Mandatory in NH)
NIA
4066524
03/01/2019
03/01/2020
%� STATUTE ERH
E.L. EACH ACCIDENT
1,000,000
$
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
1,000,U00
$
A
Leased/Rented Equipment
5C95845
11/15/2018
11/15/2019
$100,000 Limit
$1,000 Deductible
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
L;tKI IFII;AI t
City of Fort Collins
P.O. 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
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD