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HomeMy WebLinkAbout489486 TUV RHEINLAND OF NORTH AMERICA INC - INSURANCE CERTIFICATETUVRHEI-03 SSWENSON AIC'I�RO CERTIFICATE OF LIABILITY INSURANCE M/DD/YY E (M YY) 1DATE(M / 018 DfYY 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 CT NAMEA (A/C, No, Ext): (203) 702-4700 FAX No):(203) 702-4759 Rose & Kiernan, Inc. Lee Farm Corporate Park 83 Wooster Heights Danbury, CT 06810 E-MAIL D RE : INSURERS AFFORDING COVERAGE NAIC # INSURER A:Allianz Global Risks US Insurance Company 35300 INSURED INSURER B : The Charter Oak Fire Insurance Company 25615 INSURER C: Travelers Property Casualty Company of America 25674 TUV Rheinland of North America, Inc. INSURER D : 295 Foster Street, Suite #100 Littleton, MA 01460 INSURER E INSURER F : I COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: i 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. INSR LTRA TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE [X] OCCUR USL00170118 01/01/2019 01/01/2020 DAMAGE TO RENTED PR MI E ccurr nc 100,000 $ MED EXP (Any oneperson) $ 10,000 PERSONAL& ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑ JECT PRO ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT cc,de 1,000,000 $ BODILY INJURY Perperson) $ X ANY AUTO P8103343P614COF19 01/01/2019 01/01/2020 BODILY INJURY Per accident $ OWNED SCHEDULED AUTOS ONLY AUTOS PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE USL00164019 01/01/2019 01/01/2020 DED I RETENTION $ 330,000 $ 1 1 C WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE PJUB328OP50619 01/01/2019 01/01/2020 X PER OTH- TUTE E.L. EACH ACCIDENT 1,000,000 $ OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N / A E.L. DISEASE -EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT 1,000,000 $ If yes, describe under DESCRIPTION OF OPERATIONS below A Professional Liabili U5F00031719 01/01/2019 01/01/2020 Each Claim/Aggregate 6,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) See remarks attached. Project: 7218 ISO 14001 Audit Services The City of Fort Collins, its officers and employees as an additional insured with respect to General Liability but only as required by written contract/agreement performs noted. The City of Fort Collins Purchasing Division PO Box 580 Fort Collins, CO 80522 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. AUTHORIZED REPRESENTATIVE ' � .,A," � - ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: TUVRHEI-03 LOC #: 0 SSWENSON ACORN AGENCY Rose & Kiernan, Inc. POLICY NUMBER 3EE PAGE 1 CARRIER SEE PAGE 1 ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE NAMED INSURED TUV Rheinland of North America, Inc. 295 Foster Street, Suite #100 Littleton, MA 01460 NAIC CODE iEE P 1 I EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: _ACORD 25 FORM TITLE: Certificate of Liability Insurance _ General Liability: AGRL-CG6001 04/10 — Additional Insured — When required by written contract CG2010 04/13: Blanket Additional Insured - Owners, Lessees or Contractors - Scheduled Person or Organization CG2011 04/13: Additional Insured — Managers or Lessors of Premises CG2037 04113: Additional Insured - Owners, Lessees or Contractors - Completed Operations AGR-IL M002 11/03 - Amendment to Condition- Other Insurance - Primary and Non -Contributory CG2404 05/09: Waiver of Transfer of Rights of Recovery Against Others to us CG2417 10/01 Contractual Liability - Railroads Automobile Liability: CAT353 02/15: Blanket Additional Insured and Waiver of Subrogation Clauses included. Umbrella: AGR-CU 2001 07/11 Blanket Additional Insured and Waiver of Subrogation Clauses included. AGRL-CU 4003 (02-13) Amendment — Other Insurance Condition - Primary and Non -Contributory AGR-CU4503 (01-04) Waiver of Rights of Recovery Workers Compensation: WC000313 (00)-01: Waiver of Our Right to Recover from Others Endorsement WC9903J9 Kansas Waiver of our Right WC420304 - Texas Waiver of our Right WC990376 Calif Waiver of our Right Page 1 of 1 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD