HomeMy WebLinkAboutJ & R ELECTRIC INC - INSURANCE CERTIFICATECERTIFICATE I OF
:ATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE. CERTIFICATE HOLDER. THIS
>DES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS
OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) musthave ADDITIONAL INSURED provisions or be endorsed. It
SUBROGATION IS WAIVED,subject to the terms andconditions of the policy, Certain policies may require, an endorsement. A statement on this
PRODUCER
FEDERATED MUTUAL INSURANCE COMPANY
HOME OFFICE: P.O. BOX 328
OWATONNA, MN 55DS0
INSURER(S) AFFORDING COVERAGE
NAIC M
INSURER A: FEDERATED MUTUAL INSURANCE COMPANY
13935
INSURED
J dR ELECTRIC INC
4251 S"HATCHES CT STE E
ENGLEWOOD, CO 80110-8603
374-201-2
INSURER e:
INSURER (X
INSURER o-
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:
4 REVISION NUMBER: 0
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCEI
INDICATED. NOTWITHSTANDING ANY REQUIREMENT.. TERM
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE
OMITS SHOWN MAY HAVE
AND CONDITIONS OF SUCH POLICIES. O
LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
OR CONDITION . OF ANY CONTRACT OR OTHER.. DOCUMENT WITH RESPECT TO WHICH THIS
AFFORDED BY THE POLICIES DESCRIBED HEREIN 13 SUBJECT 70 ALL THE TERMS. EXCLUSIONS
BEEN REDUCED BY PAID CLAIS_.
M
LTa
TYPE OF INSURANCE
INSL
SWVD
POLICY NUMBER
POL CY EFF
MMIO V1'
POLICY EXP
MOUC YVYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE ❑X OCCUR
Y
Y
SM5825
12/30/2019
12/30/2020
EACH OCCURRENCE
$1,00D,000
DE TO REENTED varnummi
NED EXP (Any arc person)
EI00,000
EXCLUDED
G
X
PERSONAL ADV INJURY
$1,000,000
WL AGGR GA PRLIMIT APPLIES PER:
POLICY UJECTT ❑ LOC
OTHER:
GENERAL AGGREGATE
$2,000,000
.PRODUCTS-COMP/OP AGO
E2,000,000,
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
OWNS AUTOS ONLY AUTOOSSULED
HIRED AUTOS ONLY NON -OWNED
_ AUTOS ONLY
N
N
SM5825
12130/2019
12130/2020
COMBINED SINGLE UNIT
IEM w den
$1,000,000
BODILY INJURY IPer penes)
BODILY INJURY IPer wdd.nt)
PROPERTY DAMAGE
r
A
X
UMBRELLA LIAR
EXCESS LIAR
X
OCCUR
CLAIMS -MADE
N
N
9085826
12/30/2019
12/30/2020
EACH OCCURRENCE
$3,000,000
AGGREGATE
81,000,000
DEp I I RETENTION
A
INCRgRS COSIPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFTICERIMEMSER EXCLUDED! tI
(M.dalow in Min
11 ym deimm mftr
DESCRIPTION OF OPERATIONS MI..
N/ A
Y
9D85827
12130/2019
12i30/2020
-
X PER STATUTE
OTH•
ER
E.L. EACH ACCIDENT
6500,000
E.L. DISEASE - EA EMPLOYEE
$500,000
______....._ ..
EL DISEASE -POLICY OMIT
..
E500,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (=ORD 101. Addit"I
SEE. ATTACHED PACE.
RemMe Sd Ie, mey I* apedmd it M. sp. Is required)
CERTIFICATE HOLDER I CANCELLATION
374-201-2
40
CITY OF FORT COLLINS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
PO BOX 580
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
FORT COLLINS, CO 8D522-0580
ACCORDANCE WITH THE POLICY PROVISIONS..
AUTHORREO REPRESENTATIVE
0 1908-2015.ACORD CORPORATION. All rights reserved.
ACORD 25 (2018103) The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: 374-2f
LOC tX
ACORV
L� ADDITIONAL REMARKS SCHEDULE
Page 1 of 1
AGENCY
NAMED INSURED -- - - '- - -'-
FEDERATED MUTUAL INSURANCE COMPANY
J & R_ ELECTRIC INC
42M S NATCHES CT STE E
ENGLEWOOD, 00 80110.8603
POLICY NUMBER
SEE CERTIFICATE # 4.0
CARRIER
NAIL CODE
SEE CERTIFICATE# 4.0
EFFECTIVE DAM: SEE CERTIFICATE # 4.0
/MRJI 1 FvnI�L ftCmNKRa
THIS ADDITIONAL REMARKS FORM 19 A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LJABILITY INSURANCE
THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS,
LESSORS OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR
GENERAL LIABILITY.
GENERAL LIABILITY CONTAINS A WAIVER OF SUBROGATION IN FAVOR OF THE CERTIFICATE HOLDER SUBJECT TO THE CONDITIONS
OF THE BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY ENDORSEMENT.
WORKERS COMPENSATION CONTAINS A WAIVER OF SUBROGATION IN -FAVOR OF THE CERTIFICATE HOLDER.
ACORD 101 (2002M) a 9mm amen r IDDnoannu All Ai .........w
The ACORD name and logo are registered marks of ACORD