HomeMy WebLinkAboutENGINEERED STRUCTURES INC - INSURANCE CERTIFICATE (2)Ac"RD® CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDD/YYYY)
8/27/2019
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 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
The Leavitt Group of Boise, Inc.
6220 N. Discovery Way, Ste 100
Boise ID 83713
CONTACT NAME: Jamie Beswick
PHONE (208)375-9199 FAX
No: 12061658-1951
ADD RIE�; Jamie-beswick@leavitt.com
INSURER $ AFFORDING COVERAGE
NAIC a
INSURER A: National Union Fire Insurance Company c
019445
INSURED
Engineered Structures, Inc.
3330 H. Louise Drive
Suite 300
Meridian ID 83642
INSURER B: Cincinnati Insurance Company
10677
INSURERC:XL Insurance America, Inc.
24554
INSURERD:New Hampshire Insurance Company
23841
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:19-20 MASTER 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
U
POLICY NUMBER
MIDDPOLICY EFF
MOWLDDPICEXP
LIMITS
%
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 11000,000
A
CLAIMS -MADE X OCCUR
DAMAGE
PREMISES Ea RENTED
=uirence)$
300,000
MED EXP(Any one person)
$ 10,000
CL3292147
9/1/2019
9/1/2020
PERSONAL & ADV INJURY
$ 14001000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
POLICY O PRO. 7 LOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
OTHER:
AUTOMOBILE
LIABILITY
COMBINE IN L LIMIT
Ea accident
$ 11000,000
BODILY INJURY (Per parson)
$
B
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
ZDA0548478
9/1/2019
9/1/2020
JX
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
War acrident)
$
NON -OWNED
HIRED AUTOS
HIRED AUTOS N AUTOS
a
X
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE
$ 20.000,000
X
AGGREGATE
$ 20,000,000
C
EXCESS LIAB
CLAIMS -MADE
DED % RETENTION $ 10,000
$
US0009383OLI19A
9/1/2019
9/1/2020
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY YIN
X PER O H-
STATUTE ER
D
ANY PROPRIETORIPARTNERIEXECUTNE
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH)
NIA
KC25093627
9/1/2019
9/1/2020
E.L. EACH ACCIDENT
$ 1, 000, 000
E.L. DISEASE- EA EMPLOYEE
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - PO:JCY LIMIT
S 11000,000
A
California WC
NC25893628
9/1/2019
9/1/2020
Employes Llabllily-Each Accident $14001000
LGB CA Lic *OE16971
Disease policy l Each employee $1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Addltlonal Remarks Schedule, may be attached if more space Is required)
CERTIFICATE HOLDER CANCELLATION
eStanley@esicons
City of Fort Collins
300 La Porte 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
Speegle/JAHARD
i
reserved
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
IN S025 1201401,