Loading...
HomeMy WebLinkAbout495794 RELIANT HOLDINGS LTD - INSURANCE CERTIFICATE (3)A� " CERTIFICATE OF LIABILITY INSURANCE DATEDDlYYYY) (MMl(MMI019 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 CONTACT NAME: Janna Gonzalez, Certificate CSR Higginbotham Insurance Agency, Inc. PHONE FAX 817-349-2384(A/C.No): 817-347-6981 500 W. 13th Street nooRess: jgonzalez@higginbotham.net Fort Worth TX 76102 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Great American Alliance Ins. Co. 26832 INSURED RELIA8 INSURER B : Gemini Insurance Company 10833 Reliant Holdings, Ltd. Complete name shown in description INSURER c : XL Specialty Insurance Company 37885 INSURER D : Crum & Forster Specialty Ins. Co 44520 10817 West County Road 60 1 INSURER E : National Fire & Marine Ins Co 20079 Midland TX 79707 INSURER F : COVERAGES CERTIFICATE NUMBER:300679864 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 LTR I TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY VMGP003556 3/26/2019 3/26/2020 EACH OCCURRENCE $1,000,000 � OCCUR DAMAGE TCLAIMS-MADE PRRENTED EM SESOEa occu ence $ 100,000 X MED EXP (Any one person) $ 5,000 BI/PD Ded 50.000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY � PE� [X] LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: C AUTOMOBILE LIABILITY AE0004954902 3/26/2019 3/26/2020 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY E UMBRELLA LIAB X OCCUR 42UM030736801 3/26/2019 3/26/2020 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 X EXCESS LIAB CLAIMS -MADE DIED X RETENTION $ $ A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N WC111026503 WC185582303 3/26/2019 3/26/2019 3/26/2020 3/26/2020 X STATUTE X ERH Alternate Employ _ ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N N/A E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 D Contractors Pollution Liability CPL109973 3/26/2019 3/26/2020 Each Incident $1,000,000 Off -Site Policy Aggregate $1,000,000 Deductible $10,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Contractors Pollution Policy #CPL109973 — Sudden & Accidental The General Liability and Automobile Liability policies include a blanket automatic additional (includes completed operations) insured endorsement that provides additional insured status and General Liability, Automobile Liability and Workers' Compensation policy includes a blanket waiver of subrogation endorsement to the certificate holder when required by written contract. The General Liability and Automobile Liability policy has a blanket Primary & Non Contributory endorsement that affords that coverage to certificate holders only See Attached... City of Fort Collins P.O. Box 580 Fort Collins CO 80522 L�L'L`1�13�J�111�1►1 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD