HomeMy WebLinkAbout457775 FARNSWORTH GROUP INC - INSURANCE CERTIFICATE (4)P52d)028(Mr2
AGO DATE (MMIDDIYYYY)
CERTIFICATE OF LIABILITY INSURANCE 04/02/2019
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 1-800-527-9049 CONTACT NAME: Linda Bomnrito
Holmes Murphy and Associates PHONE FAX
Peoria 1AIC AQO EA: 309-282-3903 No):866-501-3945
E-MAIL 311 S.W. Water Street lbamarito9holmealnurphy.com
ADDRESS:
Suite 211 INSURER(S) AFFORDING COVERAGE NAICt
Peoria, IL 61602-4108 INSURERA: IL SPECIALTY INS CO 37885
INSURED INSURERS:
Farnsworth Group, Inc. - ----
INSURER C
2709 McGraw Drive INsurrerru:
INSURER E:
(Bloomington, IL 61704 1INSURER F:
r`AVFRAr_FC rFRTIFIrATF MIIMRFR• 55867919 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 _--�DLSUBR POLICY NUMBER --� M LICY EFF POLICY EXP LIMITS -
LTR
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
S
CLAIMS -MADE u OCCUR
4
P ,SEES EaENTocciarence
$
MED EXP (Any one person)
$
PERSONAL b ADV INJURY
$
GENERAL AGGREGATE
$
GENt
AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMPIOP AGG
f
_
POLICY JEST 11 LOC
f
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMB
Ea accident
f
BODILY INJURY (Per person)
$
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY _ AUTOS
HIRED NON -OWNED
AUTOS ONLY _ _ AUTOS ONLY
I
BODILY INJURY (Per accident)
$
PROPERTY DGE
Per accWenl
f
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
III
_
AGGREGATE
$
LIA
CLAIMS -MADE
__B
DED RETENTION$
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILfTY YIN
ANYPROPRIETORIPARTNEWEXECUTIVE
OFFICERIMEMBER EXCLUDED? IN I
N I A
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$
(Mandatory In NH)
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
$
I yes, describe under
DESCRIPTION OF OPERATIONS below
A
Professional Liability
DPR9940551
04/01/19
04/01/20
Each Claim
5,000,000
(Claims Made)
Aggregate
10,0001000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddiBonal Remarks Schedule, may be asached I more space is required)
The professional liability policy contains a 30 day notice of cancellation as required by written contract with the
insured, per policy terms and conditions.
Farnsworth Group, Inc. Project Manger: Eric Culver
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
ty of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
P.O. BOX 580 AUTHORIZED REPRESENTATIVE
215 N. Mason
Fort Collins, CO 80524 6l ' ".77
USA raC i�i L%r%'..
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
lbomaritoil
55867919
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