HomeMy WebLinkAbout113132 POWER MOTIVE CORPORATION - INSURANCE CERTIFICATE (3)Acoao- CERTIFICATE OF LIABILITY INSURANCE
�i 12/1/2019
DATE(MMIDDIYYYY)
1 9/3/2019
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 Lockton Companies
8110 E. Union Avenue
.Suite 700
Denver CO 80237
(303) 414-6000
GUN (AU I
NAM
FAX
A/C No Ext : A/C, No):
E-MAIL
ADDRESS:
INSURERISI AFFORDING COVERAGE
NAIC n
wsURERA: The Phoenix Insurance Com anv
25623
INSURED Power Motive Corporation
1438764 5000 Vasquez Blvd
Denver, CO 80216
INSURER B : Travelers Property Casualty- Co of America
�5674
INSURER C : Pinnacol Assurance Company
41190
INSURER :
INSURER E:
INSURER
r`nvcoAGcc CFRTIFICATF NIIMRFR- I SSdQ7id RFVISION NIIMRFR• XXXXXXX
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
TR
TYPE OF INSURANCE
ADDL
INSD
SUER
WVD
POLICY NUMBER
POLICY EFF
ODryyyy
POLICY EXP
IMMIDDNYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
FX
Y
N
Y-660-0K258364-PHX-18
12/1/2018
12/1/2019
EACH
OCCURRENCE
1,000.000
DAMAGE
PREMISES
TO RENTED
Ea occurrence
300,000
MED EXP (Any oneperson)
5,000
PERSONAL & ADV INJURY
$ 1.000.000
GEN'L AGGREGATE LIMIT APPLIES PER.
X POLICY PRO-
JECT LOC
OTHER
GENERAL AGGREGATE
$ 2,000 000
PRODUCTS - COMP/OPAGG
$ 2.000,000
$
E3
AUTOMOBILE
LIABILITY
ANY AUTO
OWNEDSCHEDULEDBODILY
ONLY AUTOSAUTOS ONLY X AUUTOS ONL�
Y
N
810-IL385426-I8-14-G
12/1/2018
12/1/2019
(EaCOMaBBIINEeDtSINGLELIMIT
$ 1,000,000
BODILYINJURY(Perperson)
$ XXXXXXX
INJURY (Per accitlent
$ XXXXXX}(AUTOS
Ix
PROPERTY
amiden DAMAGE
$ XXXXXXX
$XXXXXXX
H
X
UMBRELLALWB
EXCESS LIAR
1 X
OCCUR
CLAIMS -MADE
N
N
CUP-OK270003-18-14
12/1/2018
12/1/2019
EACH OCCURRENCE
$ 10.000 000
AGGREGATE
$ 10.000.000
DED RETENTION $
$ XXXXXXX
C
WORKERS COMPENSATION
AND EMPLOYERTLWBILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED'
(Mandatory in NH)
It yes, dewnbe uWer
DESCRIPTION OF OPERATIONS W.
N / A
N
405519$
10/1/2019
10/1/2020
){ STATUTE ER
EL EACH ACCIDENT
$ 500,000
EL DISEASE - EA EMPLOYEE
500 ���
E L. DISEASE - POLICY LIMIT
500:000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, my be attached If more space Is required)
RE: City of Fort Collins is an additional insured on general liability and automobile liability if required by written contract.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
15549234 AUTHORIZED REPRESENTATIVE
City of Fort Collins
P.O. Box 580
Fort Collins, CO 80522
All rights reserved
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