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Home My WebLink AboutTRI-STATE GENERATION & TRANSMISSION ASSN INC - INSURANCE CERTIFICATEA` ® DATE (MMIDD/YYYY) `,.►" CERTIFICATE OF LIABILITY INSURANCE 02/28/28/20192019 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 N A MCGRIFF, SEIBELS & WILLIAMS, INC. NAME: FAX P.O. Box 10265 (A/C No. Ext): 800 476 2211 A/C, No): Birmingham, AL 35202 E-MAIL - ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC 0 INSURED INSURERS :LM Insurance Corp Tri-State Generation & Transmission Association, Inc. INSURER C_: 1100 West 116th Avenue Westminster, CO 80234 INSURER D INSURER E COVERAGES CERTIFICATE NUMBER:LY5HWRWG 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. INTRR TYPE OF INSURANCE AD D WVDsUSR POLICY NUMBER POLICY M/L DYEFF lYYYY MMLICY EXP / DrYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE F7 OCCUR PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY _ AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ GEN'L POLICY PRO ❑ JECT LOC PRODUCTS - COMP/OPAGG $ _ $ OTHER: AUTOMOBILE LIABILITY COMBINED GL MI Ea accident BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per axident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY A UMBRELLA LIAB Hx OCCUR XL5054808P ggregate as Applicable 03/01/2019 03/01/2020 EACH OCCURRENCE $ 5,000,000 X AGGREGATE $ 5,000,000 EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION PER OTH- LITE ER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNERIEXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUE ❑ N/A E.L. DISEASE - EA EMPLOYEE - $ (Mandatory m NH) If yS describe under DESCRIPTION OF OPERATIONS below --" "----__-"-----" E.L. DISEASE - POLICY LIMIT - -- — ---"—'"---- $ A Excess Workers' Compensation WC5051408P 03/01/2019 03/01/2020 tatutory Excess o B EW5-69N-550314-039 Each Accident or Each $ 35,000,000 (CO Only) Employee for Disease $ 35,000,000 $ $ DESCRIPTION OF OPERATIONS I LOCATIONS ! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: To obtain an easement across The City of Fort Collins, Colorado property to access the Richard Lake Substation. Certificate Holder is included as Additional Insured (excluding Workers' Compensation) as required by written contract, subject to policy terms, conditions, and exclusions. CERTIFICATE HOLDER CANCELLATION Real Estate Services Manager City of Fort Collins P.O. Box 580 Fort Collins, CO 80522-0580 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 > >" Page 1 of 1 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD