Loading...
HomeMy WebLinkAboutOLESEN ELECTRIC LLC - INSURANCE CERTIFICATE (4)CERTIFICATE OF LIABILITY INSURANCE DATE 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 terns 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: _ PinnacolAssurance PHONE FAX 7501 E. Lowry Blvd. WC, No, Eltt): NO: Denver, CO 80230-7006 ADDRESS: INSURED Olesen Electric LLC 327 West Cty Rd 66 Fort Collins, CO 80524 INSURER(S) AFFORDING COVERAGE NAIL 8 INSURER A: PInnacol Assurance 41190 INSURERS: INSURER C: INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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 I TYPE OF INSURANCE LTR (ADDL:SUBR POLICYNUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEE i To PREMISES Ea occunence S CLAIMS -MADE OCCUR MED EXP (Any one pawn) S PERSONAL B ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY ❑ JECT LOC PRODUCTS - COMP/OP AGG S S OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT e accident $ BODILY INJURY (Per pawn) S ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) S PROPERTY DAMAGE Meraeddent S HIRED NON -OWNED AUTOS ONLY AUTOS ONLY s �--I UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE S AGGREGATE S DED RETENTION AANYPROPRIETOR/PARTNER/EXECUTIVE WORKERS COMPENSATION AND EMPLOYERS' UABIUTY AND Y OFFICERIMEMBER EXCLUDED? ❑ (Mandatory in NH) NIA 4108046 09/01/2019 O9iO1iZ020 X E.LEACHACCIDENT $500,000 E.L DISEASE - EA EMPLOYEE s 500,000 Ityes. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Unless otherwise stated in the policy provisions, coverage in Colorado only. Refer to the Acord 101 Additional Remarks Schedule for supplemental cancellation notification information. CERTIFICATE HOLDER CANCELLATION 2015866 City of Fort Collins PO Box 580 Fort Collins. CO 80526 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 Pinnacol Assurance ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ACORDs provided by Forms Boss. www.FormsBoss.com. (c) Impressive Publishing 800-208-1977