HomeMy WebLinkAboutPTACEK ENTERPRISES INC - INSURANCE CERTIFICATEA`ORO® CERTIFICATE OF LIABILITY INSURANCE
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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 endorsements .
PRODUCER
Molyneaux Insurance Inc.
5025 Utica Ridge Rd, Ste 100
Davenport IA 52807
CONTACT
NAME: Kelly Webber
PHONE 563 324-1011 FAX No : 563-3247909
t'VCEMAIIN Ent,L
ADDREss: kelly.webber@molyneaux.com
INSURERS AFFORDING COVERAGE
NAIC N
INSURER A: Travelers Property Casualty Ins Company
36161
INSURED PTACENT•01
INSURERB: The Standard Fire Insurance CO
19070
Ptacek Enterprises, Inc.
dba Batteries Plus Bulbs
INSURER C: Travelers Property Casualty Co of America
25674
INSURER D:
1107 W. Drake, Unit E-3
NSURER E:
Fort Collins CO 80526
INSURER F :
COVERAGES CERTIFICATE NUMBER: 1597884210 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
TYPE OF INSURANCE
ADDL
SUER
NUMBER
POLICPOLICY
MMIDDYIYYYY
MMIDD/Y1'YY
LIMITS
C
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE 1XI OCCUR
Y
6802289W988
8/8/2019
8/8/2020
EACH OCCURRENCE
$2.000,000
PREMISES Ea occurrence
$300,000
$ 5,000 _
$ 2,000.000
MED EXP (Any one person)
PERSONAL $ ADV INJURY
GEN'L AGGREGATE LIMIT APPLIES PER:
%t POLICY JET LOC
OTHER:
GENERAL AGGREGATE
$4,000,000 _
$4,000,000
$
PRODUCTS - COMP/OP AGG
A
AUTOMOBILE LIABILITY
X ANY AUTO
OWNED SCHEDULED
AUTOS ONLYNAUTOS
X HIRED NON -OWNED
AUTOS ONLYAUTOS ONLY
BA615D3648
8/8/2019
8/8/2020
COMBINED IN LE LIMI
Ea accident
$ 1,000,000
BODILY INJURY (Per person)
$
II
$
BODILY INJURY (Per accident)
PROPERTY DAMAGE
Per accident
$
C
X
UMBRELLALRe
EXCESS LIAR
X
OCCUR
CLAIMS -MADE
CUP206JW503
8/8/2019
8/8/2020
EACH OCCURRENCE
$1,000,000
AGGREGATE
$1,000,000
DED I X I RETENTION E
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LUIBILITY
ANYPROPRIETOR/PARTNERIEXECUTIVE YIN
OFFICERIMEMBER EXCLUDED? 7'
(Mandatory In NH)
If yes, desmbe under
DESCRIPTION OF OPERATIONS below
N/A
U84J020B14
BIBl2019
8/8/2020
X PERTTE ERTH-
STA
EL EACH ACCIDENT
S1,000000
E.L. DISEASE - EA EMPLOYEE
$ 1,000.000
E.L. DISEASE- POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Fort Collins Utilities
700 Wood St
Fort Collins CO 80521
All rights reserved
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD