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Home My WebLink AboutPOWER SURVEY LLC - INSURANCE CERTIFICATEtp ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04/01/2019 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 MARSH USA, INC. 1717 Arch Street Philadelphia, PA 19103 Attn: Philadelphia.certs@Marsh.com Fax: 212-948-0360 CONTACT NAME: PHONE I FAX a N ac No): ADDRESS: INSURER S AFFORDING COVERAGE NAIC # INSURER A: Philadelphia Indemnity Insurance Company 18058 CN101307278-POWER-CAS-19-20 _ INSURED Power Survey LLC 1 County Road INSURER B : Travelers Indemnity Company of Connecticut 25682 INSURER C : Travelers Property Casualty Co. Of America 25674 INSURER D : Secaucus, NJ 07094 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: CLE-006307808-02 REVISION NUMBER: 2 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR PHPK1961589 04/01/2019 04/01/2020 EACH OCCURRENCE $ 1,000,000 AMA E T RENTED PREMISES Ea occurrence $ 10Q000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER. X POLICY1:1 JECT❑LOC OTHER GENERAL AGGREGATE $ 2,000,000 2,000,000PRO $ B AUTOMOBILE LIABILITY X ANY AUTO X OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED NON -OWNED AUTOS ONLY AUTOS ONLY 810-8M755446-19-G COMP/COLL DED: 1,000 04/01/2019 04101/2020 Ea a.cideD1SINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ Per acPROPEcRid Y DAMAGE $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? F_N] (Mandatory in NH) If yes describe under DESCRIPTION OF OPERATIONS below NIA UB-3K403043-19-43-G 04/01/2020 H X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 $ 1.000,000 E L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ 1,000.000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins is included as Additional Insured where required by written contract, except for Workers Compensation. L:tK 1 It-II:A I It: City of Fort Collins 222 Laporte Ave. Fort Collins, CO 80521 VMI\VLLLM I IVr\ 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 of Marsh USA Inc- Manashi Mukherjeeauao V 18bS-ZU1b AL:UKU l.uKI-UKA I IUIV. Au rlgnrs reserveu. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD