HomeMy WebLinkAbout112903 BRIAN'S ELECTRIC CO LLC - INSURANCE CERTIFICATE (2)02/18/2019 MON 11:06 FAX 9703784820 SECURITY INSURANCE GROUP
0002/004
Fax: (970)221-6270
,- CERTIFICATE OF LIABILITY INSURANCE
AC�RIP2/1812019
FDATE(MM1DDn vY)
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 endorsements .
PRODUCER
CONTACT
NAME: Jodi Witter
ONE g70 378 4818 FAX No : 970 378 4820
IA "PHIr
Security Insurance Group, LLC
F-MAIL jodi@securityinsuran egraup.net
8219 W 20th St, Ste A
INSURERS AFFORDING COVERAGE
NAIL n
Greeley, CO 80634
INSURER A: Auto Owners Insurance
32700
INSURED
INSURER B: Owners Insurance Company
18988
IN SURER C:
Brian's Electric Co, LLC
INSURER D :
141 D Webster Ave
INSURER E:
Fort Collins, CO 80524-4718
INSURER F :
rnxiF:RAe7FfS CFRTIFICATF NI IMRFR• nnnnnnan_VARn7F5 RFVISI(TN NIIMRFR- AfI0
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.
INSR
TR
OF INSURANCE
ADDLITYPE
imgn
SUBR
POLICY NUMBER
MOLICY ""1 EFF
MM DPOLID FXP
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
OCCUR
Y
Y
74103606
03/0312019
03/0312020
EACH OCCURRENICE
$ 1 ODD ODD
DAMCL.AIMS-M.ADE
.AI ESf a NQQ )
$ 300,000
MED EXP (Any one person)
$ 101000
PERSONAL!➢ ADV INJURY
$ 1 DDDOOD
GEN'L AGGREGATE LIMIT .APPLIES PER:
PRO-
POLICY/LOC
OTHER'
GENERAL AGGREGATE
$ 2 ODD ODD
PRODUCTS - COMPIOPAGG
$ 2,000,00
$
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY .AUTOS
HIRED NON -OWNED
AUTOS ONLY .AUTOS ONLY
Y
Y
4941848602
0310312019
03103/2020
(Ea accideDSINGLE LIMIT
$ 1 DDD ODD
BOD I LY I NJ URY(Per person)
$
BOD I LY I NJ URY (Per a ccid ant)
$
PROPERTY DAMAGE
P r a ci =ntl
$
B
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
4941848601
03/0312019
03/0312020
E.ACHOCCURRENCE
$ 1,0DD,ODD
AGGREGATE
$
DED I I RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN N
ANY PROPRI ETORIP.ARTNERlEXECUTIVE ❑
OFFICERIMEMBER EXCLUDED?
(Mandatory in NH)
If yesdescribe under
DESCRIPTION OF OPERATIONS below
N f A
PER OTH-
. TLITE
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EM PLOYEE
$
E.L. DISEASE - POLICY UMIT
$
A
Rented Equipment
74103606
0310312019
0310312020
59,00
DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule.Inay be attached if more space is required)
EK I IFICA 1 t_
City of Fort Collins
Streets Department
625 9th St.
Fort Collins, CO 8101524
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORRED REPRESENTATIVE
O 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
Printed by JMW on February 18, 2019 at 11:02ANI