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HomeMy WebLinkAbout489486 TUV RHEINLAND OF NORTH AMERICA INC - INSURANCE CERTIFICATE (2)19k TUVRHEI-03 SSWENSON CERTIFICATE OF LIABILITY INSURANCE DATE (MMlDD/YYYY)12/21/2018 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 Rose & Kiernan, Inc. Lee Farm Corporate Park 83 Wooster Heights CONTACT A] N, Ext): (203) 702-4700 ac, No):(203) 702-4759 EDDRL INSURERS AFFORDING COVERAGE NAIC # Danbury, CT 06810 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 COVERAGES CERTIFICATE NUMBER: 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR USLOO170118 01/01/2019 01/01/2020 DAMAGE TO RENTED P M occ rr nc $ 100,000 MED EXP (Any oneperson) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER, X POLICY PRO LOC JECT GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT a a ent $ 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 accdent $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LAB CLAIMS -MADE USLOO164019 01/01/2019 01/01/2020 DED I X I RETENTION $ 330,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A PJUB3280P50619 01/01/2019 01/01/2020 X PER OTH- TATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1, 00,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,0000,000 A Professional Liabili U5F00031719 01/01/2019 01/01/2020 Each Claim/Aggregate 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) See remarks attached. City of Fort Collins as an additional insured with respects to General Liability and Automobile Liability but only as required by written agreement performs noted. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Fort Collins ty THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 215 N Mason St, 2nd Floor P.O. Box 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80525 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 SSWENSON l ACORO LOC #: 0 ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED Rose & Kiernan, Inc. TUV Rheinland of North America, Inc. _ 295 Foster Street, Suite #100 POLICY NUMBER Littleton, MA 01460 EE PAGE 1 CARRIER NAIC CODE EE PAGE 1 SEE P 1 EFFEC11VEDATE: SEE PAGE 1 ADDITIONAL 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 04/13: 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