HomeMy WebLinkAbout111389 SUPER VACUUM MANUFACTURING INC - INSURANCE CERTIFICATE® DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 09/20/2019
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: Roxanne Fitzgerald
Flood and Peterson PHONE (970)356-0123 FA (970) 330-1867
AID No Ext : AIC, No
PO Box 578 nnnpaccc RFitzgerald@flocdpeterson.com
INSURER(S) AFFORDING COVERAGE
NAIL N
Greeley CO
80632
INSURERA:
Charter Oak Fire Insurance Company
25615
INSURED
INSURER B :
Travelers Property Casualty Company of America
25674
Super Vacuum Manufacturing Company, Inc.
INSURER C :
Pinnacol Assurance
41190
Po Box 87
INSURER D :
INSURER E :
Loveland CO
80539
1 INSURER F:
rnveew r_ee n`COTmI! ATC all 1aaRCD•
CL1992031546
RFVICIntj MI IIUI
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.
LTR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
MM DD/YYYY
MM ODNYYY
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
g 1,000,000
CLAIMS -MADE � OCCUR
PREMISES Ea occurrence
$ 100,000
MED EXP (Any one person)
$ 5,000
PERSONAL &ADV INJURY
$ 1.000,000
A
Y
630-7359L905-COF-18
12/01/2018
12/01/2019
GEN'LAGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
s 2.000,000
POLICY PRO ❑ LOC
JECT
PRODUCTS-COMP/OP AGG
g 2.000,000
Blanket Waiver of Subro
s
DTHER.
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
BODILY INJURY (Per person)
$
X ANYAUTO
A
x OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
Y
810-7359L905-COF-18
12/01/2018
12/01/2019
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
Underinsured motorist BI
s
X
UMBRELLA UAB
OCCUR
EACH OCCURRENCE
S 6,000,000
ki
AGGREGATE
g 6,000,000
B
EXCESS LIAR
CLAIMS -MADE
CUP-OK081738-TIL-18
12/01/2018
12/01/2019
LIED I X1 RETENTION $ 0
$
O
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE �
OFFICERIMEMBER EXCLUDED9
(Mandatory In NMI
NIA
4014258
10/01/2019
10l01/2020
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$ 500,000
E.L. DISEASE - EA EMPLOYEE
$ 500,000
If res. describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE -POLICY LIMIT
$ 500,000
Limit of Liability
5,000,000
A
Garagekeepers Legal Liability
810-7359 L905-COF-18
12/01 /2018
12/01/2019
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Addttlonal Remarks Schedule, may be attached If mom space Is requlredl
City of Fort Collins & Routine Fire Authohty is included as an Additional Insured with respect to General Liability and Auto Liability as required by written
contract.
GLelli
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Fort Collins Purchasing Department ACCORDANCE WITH THE POLICY PROVISIONS.
215 North Mason 2nd Floor
AUTHORIZED REPRESENTATIVE
PO Box 580
Fort Collins CO 80522 4A,,,,,_—�l2 ov�_Ld
(0 1988-2015 ACORD CORPORATION. All rlgnts reserved.
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