HomeMy WebLinkAbout457775 FARNSWORTH INC - INSURANCE CERTIFICATEACORO®
`� CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DONYYY)
3/31/2020
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 (NSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poliey(les) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and condhions 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 endorsements .
PRODUCER
Cottingham 81 Butler
Robert Heath
860 Main St,
CONTA
NAME:'
PHONE FAX
• 563-587-5000 ac No : 563-583-7339 _
E-MAIL RESS:
INSURERS AFFORDING COVERAGE
NAIC If
Dubuque. IA 52001
INSURER A: -Hartford -Fire Insurance Company
19692
INSURED FARNGRO-01
Farnsworth Group, Inc.
2709 McGraw Drive
INSURER B:Travelers.Pr0 a Casualty Company of America
25674
INstiReRc: Twin City Fire Insurance Co.
29459
Bloomington IL 61704
INSURER D
INSURER E
..INSURER IF: _
rnvcoer_oc rCDTIRICATP WIJMIPI171d57dQ11 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 HAVEBEEN 'BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
I=
wynADDLSUBR
NUMBER
POLIC.POLICY.
MM DDYEFF/YYYY
PM DDY EXP
LIMITS
A
X
COMMERCIALGENERALLUIBILITY
83 UEN OB 8121
4/1/2020
4/1/2021
EACH OCCURRENCE
$ 1,060,000
CLAIMS -MADE FX-1 OCCUR
DAMAGE TO RENTED
PREMISES Ea occurrence
$ S00,000
MED EXP (Any. onePerson)
$ 10,600
PERSONAL 8 ADV INJURY
$ 1,060,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,060,000
PRODUCTS, COMP/OP AGG
.$2,060,000
POLICY JECT I XI LOC
$
OTHER:
A
AUTOMOBILE LIABILITY
83UEN
4/1/2020
4/1/2021
-
COMBI) GLELIMIT
Ea accidentdentOB8122
$1,000,060
BODILY INJURY (Per person)
$
X ANY AUTO
BODILY INJURY (Per accdent)
$
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTYDntAMAGE
Per accide
$
B
X
UMBRELLALIAB
X
OCCUR
ZUP-61M71617
4/l/2020
4/1/2021
EACH OCCURRENCE
$6,000,000
AGGREGATE
$6,000,000
EXCESS LIAR
CLAIMS -MADE
DED RETENTION
$
p
WORKERS COMPENSATION -
AND EMPLOYERS' LIABILrrY
ANYPROPRIETOR/PARTNER/EXECUTIVE YIN
83 WEOB8GOH
4/1/2020
4/1/2021
X STATUTE ERH
_
E.L. EACH ACCIDENT
E1,000,000
E.L. DISEASE- EA EMPLOYEE
$ 1,000,000
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
N/A
E.L. DISEASE .-POLIC-LIMIT-_$1,000,000_-
If yes, describe under
DESCRIPTION OF OPERATIONS. below.
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
Project Name: City of Fort Collins On -Call Services
Project Manager. Bruce McLennan
The Certificate holder is additional insured on the General Liability and.Auto Liability policies per written contract between the named insured and the certificate
holder that requires such a status subject to the terms and conditions of the endorsement attached to the policy.
CERTIFICATE HOLUEK VNIIVCLV\I IVII
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, ,NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Fort Collins
215 N. Mason St. 2nd Floor AUTHORIZED REPRESENTATIVE
Fort Collins CO 80522
-0—
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