HomeMy WebLinkAboutPOWER SURVEY LLC - INSURANCE CERTIFICATE (2)AC40REP CERTIFICATE OF LIABILITY INSURANCE
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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 NOTICONSTITUTE 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 of tie endorsed. -
If SUBROGATION IS WAIVED, subject to the temis and conditions of the policy, certain policies may require an end6merhent A statement on
this certificate does not confer rights to the certificate holder in lieu of_such endomeme s .
PRODUCER
'MARSH USA, INC.
TWO ALLIANCE CENTER
3560 LE14OX ROAD, SUITE 2400
ATLANTA,GA 30326
CONTACT
NAME:
PHONE IFAX
nIC NO)'
E4A RIE
.INSURER(S) AFFORDING COVERAGE
NAICd
INSURER A: Old RepublicInsurance Cc
24147
CN101742660_-POWER-CAS-20-21
INSURED
Power Smey LLC
County Road
INSURER B :_NIA
WA
INSURER C : N/A
N/A
INSURER D : NIA
WA
Secaucus, NJ 07094
INSURER E : WA
NIA
INSURER F
-wwG�e��w�e nrorrarwte unianeo. AT] "JMR)WJLnR ROVIRMIM NIIMRER_ 2
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOWTHE POLICY PERIOD:
CERTIFICATE MAY T ISSUED OR MAY PERTAIN, THERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS'
(EXCLUSIONS AND CONDITIONS OR SUCH EPOLICIES. LIM, INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS;'
ITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
7YPEOFINSURANCE_...
D L
UK
I POLICY. NUMBER
POLICY EFF
MIDDIVYYYYY
M DY EXP)
_ ..- LIMITS .. _ .
A
X
doMMERCIALGENERALLIAwuTY
MWLY31489420
07101/2020
0710112021
EACH OCCURRENCE
$ 2,ODO,000
CLAIMS -MADE M OCCUR
DAMAGE TO RENTED
PREMISES Ea- nce
$ 2,D0.0,000
MED EXP one person)-.
$ 5,000
PERSONAL&ADV. INJURY
$ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE.
00
$ 4'000'1
PRODUCTS - COMP/OP AGO
S - 41019
- LOC
X POLICY [::]Re
$
OTHER:
-
-
'SINGLE
- -
A
AU romostLELUIalurr
MWTB 31562D 20
07/Ot/2020
07101I2021
Ea-COaccKlKlent)rD
S 21000,000
BODILY INJURY (Per person)
$
X ANY AUTO
BODILY INJURY (Per accident)
$
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NGN-OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
Per accldem
$
UMBRELLA LUU
OCCUR
I
EACH OCCURRENCE
$
AGGREGATE
-$
EXCESS (JAB
CLAIMS -MADE
DED I I RETENTION
$
I
- --
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRIETOR/PARTNERIEXECUTIVE YIN
OFFICERMIEMBEREXCLUDED9 F-N�
(Myaensdatory in NH)
DEODO
$CRI � OFOPERATIONSbelwr
I
NAA
_ _
-
MWC.31561
- -- - _
X STATUTE ER
E.L. EACH ACCIDENT
-
S 1.000,000
E.L. DISEASE -EA EMPLOYEE
$ 1-,000,OOO
E.L. DISEASE - POLICY LIMIT
$ �':
I
_
DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (ACORD 101, Additional Remada Schedule, may be aMached N more span Is reWmcl)
City of Fort Collins is included as Additional Insured where required by written contract, except for Workers Compensation.
City of Fort Collins
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
222 Laporte Ave.
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Fart Collins, CO 80521
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATNE
of Marsh USA Inc.
Sandi Lee ,cnllzQ,hGLh. lard
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l4J T906-A06 FL .Umu VVIRr•VrW Irvre. ran nyuw roaar�ou.
ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD