HomeMy WebLinkAbout114215 MERIT ELECTRIC INC - INSURANCE CERTIFICATE (10)AFRO® CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/2019 Y)
o7/o1/o19
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 Jennifer Winter, CISR
NAME:
Flood and Peterson
HONE Ext : (970) 506-3206 FVC No): (970) 506-6846
E-MAIL JWinter@floodpeterson.com
ADDRESS:
PO Box 578
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A: Union Insurance Company of Providence
21423
Greeley CO 80632
INSURED
INSURER B ; EMCASCO Insurance Company
21407
INSURER C : Employers Mutual Casualty Company
21415
Merit Electric, Inc.
INSURER D : Pinnacol Assurance
41190
2590 Midpoint Drive
INSURER E :
INSURER F :
Fort Collins CO 80525
rnyFRAr:I:R CFRTIFICATE NUMBER- CL197130177 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.
ILTR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
MM/DDY/YYYY
MM/DDIIYYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE Fx_] OCCUR
PD Ded:5,000
6DO735920
07/01/2019
07/01/2020
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES Ea occurrence
500,000
$
X
MED EXP (Any one person)
$ 10,000
PERSONAL& ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY F JRO PRO FX] LOC
OTHER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
B
AUTOMOBILE LIABILITY
X ANYAUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
X AUTOS ONLY H AUTOS ONLY
X DOC
6EO735920
07/01/2019
07/01/2020
COMBINED SINGLE LIMIT
(Ea accident
$ 1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
$
C
X
UMBRELLA LIAB
EXCESSLIA6
X
OCCUR
CLAIMS -MADE
6JO735920
07/01/2019
07/01/2020
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 5,000,000
DED I X1 RETENTION $ 0
$
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUDED?
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
4070414
07/01/2019
07/01/2020
X
/� STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 580
AUTHORIZED REPRESENTATIVE
Fort Collins CO 80522-0580 I
U 1988-205 AGUKU GUKF'UKAI IUN. All rignts reservea.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD