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HomeMy WebLinkAbout585133 BADGER LDAYLIGHTING CORP - INSURANCE CERTIFICATE® DATE (MM/DD/YYYY) AC� A."- CERTIFICATE OF LIABILITY INSURANCE 07/01/2019 %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 CONTACT Marsh Canada Limited -NAME.,_- PHONE FAX 120 Bremner Blvd., Suite 800 Attn: Canada. Certfequest@marsh.com C. No. Ext), "A No)__ Toronto, ON, M5J OA8 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC #__ CN102102280-PPJ-GAWUP-19-20 INSURER A: Liberty Mutual Insurance Company 23043 INSURED INSURER B: Liberty Mutual Fire Insurance Company 23035 Badger Daylighting Corp 8930 Motorsports Way INSURER C : Brownsburg, IN 46112 INSURER D INSURER E: I INSURER F : 1 cnVFRAnrQ r`FRTIFICATF NIIIIARFR• HDU-003462464-03 RFVISION Nt1MRFR- 1 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR 1HE 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 TEE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR ADDLITYPE OF INSURANCE INSD SV D POLICY NUMBER MM/DD YYYY MMPOLICYEFF L EXP LTR DD ICYYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY X X TB1-B71-171080-039 07/01/2019 07/01/2020 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE � OCCUR DAMAGE TO TE PREMISES Ea otccur ence $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY PRO- jE LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER. A AUTOMOBILE LIABILITY X X AS1-B71-171080-049 OT01/2019 0710V2020 COMBINED SINGLE LIMIT Ea accident $ 2,000,000 BODILY INJURY (Per person) $ X ANY AUTO X OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY $ X UMBRELLA LAB X OCCUR X X 1000212108-04 07/01/2019 07/01/2020 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 EXCESS LIAB CLAIMS -MADE DED I X I RETENTION $ 10,000 $ B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? ❑N (Mandatory in NH) NIA X WA2-B7D-171080-069(AOS) WC2-B71-171080-059 (WI) 07/01/2019 07/01I2020 07/01/2020 X PER OTH- STATUTE ER E. L. EACH ACCIDENT $ 1,000,000 - E L. DISEASE - EA EMPLOYEE —_ $ 1,000,000 E1 DISEASE - POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below A Pollution Liability TI1TO1ABHZ2R119-Ded: $25,000 07/01/2019 07/01/2021 Each Incident 10,000,000 Claims -Made Aggregate 10.000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins, its officers, agents, and employees are included as additional insured (except workers' compensation and pollution) where required by written contract. Waiver of subrogation is applicable where required by written contract. 1`FRTIFI1-ATF 1-InI r1FR rAN1rFI I ATIAN City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO Box 580 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Fort Collins, CO 80522 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee _- 1&MN^ 6-!>— .tom--►v+y)c� ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN102102280 LOC #: Canada A ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY Marsh Canada Limited NAMED INSURED Badger Daylighting Corp 8930 Motorsports Way Brownsburg, IN 46112 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance General Liability: Designated Project General Aggregate(s): General Aggregate Limit shown on the Declarations, Total Aggregate Limit for all Projects and Locations: $15,000,000 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD