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HomeMy WebLinkAbout520431 SCHEIDT & BACHMANN USA INC - INSURANCE CERTIFICATE (2)�1 AFRO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 01 /07/2019 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 Aon Risk Services Northeast, Inc. Boston MA Office CONTACT NAME: A/CC..NNo. Ext): (866) 283-7122 wC. No.): 800-363-0105 E-MAIL ADDRESS: 53 State Street Suite 2201 Boston MA 02109 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Travelers Casualty&Surety Co of America 31194 Scheidt & Bachmann USA Inc INSURER B: Travelers Property Cas Co of America 25674 1001 Pawtucket Blvd Lowe Lowell MA 01854 USA INSURERC: The Travelers Indemnity Co of CT 25682 INSURER D: XL Insurance America Inc 24554 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570074702726 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. Limits shown are as requested ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM DD/YYYY LIMITS D X COMMERCIAL GENERAL LIABILITY US 1 4 LI A 1 1 1 1 EACH OCCURRENCE $1 , 000 , 000 CLAIMS -MADE -1 OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $100,000 X MED EXP (Any one person) $10 , 000 Per Doc Ded $15,000 PERSONAL &ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY ❑ PRO JECT ❑ LOC PRODUCTS - COMP/OPAGG $2,000,000 OTHER: Emp Benefits Per Claim $1 , 000 , 000 B AUTOMOBILE LIABILITY 810- 9199c532 01/01/2019 01/01/2020 COMBINED SINGLE LIMIT (Ea accident $500,000 BODILY INJURY ( Per person) BODILY INJURY (Per accident) OWNED SCHEDULED IPerANYAUTO AUTOS ONLY AUTOS HIREDAUTOS NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE accident Comp/Coll Deductible $1, 000 UMBRELLA LAB EACH OCCURRENCE AGGREGATE EXCESS LIAB HOCCUR CLAIMS -MADE DIED RETENTION C WORKERS COMPENSATION AND EMPLOYERS' LIABILITYER ANY PROPRIETOR / PARTNER / EXECUTIVE Y / N UB9J391799 01/01/2019 01/01/2020 X STATUTE OTH E.L. EACH ACCIDENT $100 , 000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A E.L. DISEASE -EA EMPLOYEE $100 , 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASEPOLICYLIMIT $ 500 , 000 A D&O-Primary 105721510 12/20/2018 12/20/2019 Each LOSS Limit $2,000,000 Claims Made Retention $50,000 SIR applies per policy terns & conditions DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins is included as additional with respect to the general liability policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins AUTHORIZED REPRESENTATIVE 215 North Mason Street, 2nd Floor Fort Collins Co 80524 USA e�4'on �����D�fc �clttrceD c/la,G�1 �na ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 10603646 LOC #: '4 ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk services Northeast, Inc. NAMEDINSURED Scheidt & Bachmann USA Inc POLICY NUMBER see certificate Number: 570074702726 CARRIER see certificate Number: 570074702726 NAIC CODE EFFECTIVE DATE' ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YYYY POLICY EXPIRATION DATE MM/DD/YYY LIMITS GENERAL LIABILITY D us00010045LI19A 01/01/2019 01/01/2020 Emp Benefits Aggregate $1,000,000 ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD