Loading...
HomeMy WebLinkAboutRA SMITH NATIONAL / CHRIS PINKOWSKI - INSURANCE CERTIFICATERASMITH-01 CTHOMPSON A�O�RO CERTIFICATE OF LIABILITY INSURANCE DATE 07/01/2019Y) 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 NAME: Johnson Insurance Milwaukee PHONE FAX 1103 Hunter Dr Ste 100 M( C, No, E:t): (800) 776-7055 (A/C, No):(877) 254-8586 Mount Pleasant, WI 53406 ID !Ass: info@johnsonin.s.com ___. __ _ _ INSURERS) AFFORDING COVERAGE NAIC INSURER A:RLI Insurance Company13056 INSURED IN_S_U_R_E_R_ B : R.A. Smith National, Inc. Chris Pinkowski INSURER C 16745 W. Bluemound Rd, Ste 200 INSURER 0: Brookfield, WI 53005-5938 INSURER E : INSURER F : r`r1VCDA!_CC r`c0rinr`Ar0 11,11uAnco. 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 LIR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE _ DAMAGE TO RENTED PREMISES (Ea occurrence $ $ $ MEDEXPJAny one person PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: 7-11 GENERAL AGGREGATE $ _ POLICY JECT LOC PRODUCTS - COMP/OP AGG $ OTHER: AUTOMOBILE LIABILITY [ e aBINED SINGLE LIMIT $ $ ANY AUTO OWNED SCHEDULED BODILY INJURY �person _ - _ AUTOS ONLY AUTOS BODILY INJURY Per accident) PRRppPERTY AMAGE P� eracddent $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY _ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DIED RETENTION $ _ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) describe under NIA t PER OTH- $TAWT E.L. EACH ACCIDENT DISEASE. -EA EMPLOY $ $ UE.L- DUes, DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT A Professional Liab RPDO036797 07/01/2019 07/01/2020 Per Claim 2,000,000 A Professional Liab RPDO036797 07/01/2019 07/01/2020 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Fort Collins 300 LaPorte Ave. Fort Collins, CO 80521 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 ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD