HomeMy WebLinkAbout535404 ADVANCED TECHNIPILES - INSURANCE CERTIFICATEOP ID: SC
CERTIFICATE OF LIABILITY INSURANCE
D05/18/201ATE YY)
05118/2015
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 CONS71TUTE 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 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 endorsements).
PRODUCER Phone:970-223-1804
CONTCT
NAMEA
Front Range Insurance Group
1100 Haxton Drive Suite 100 Fax:
Fort Collins, CO 80525
David A. Wooldridge LUTCFAAI
PHONE ---- - _- ---- x -
Alc No Exq:. _
E-MAIL
DDRESS:
APRODUCER
CUSTOMER ID j: ADVAN06
INSURERS AFFORDING COVERAGE NAIC 0
INSURED Advanced Technipiles, Inc.
INSURERA: Pinnacol Assurance
41190
Charlie Mcalif
_
INSURERS: Gemini Insurance Co
418 Dunne Dr.
Fort Collins, CO 80525
INSURER c
INSURER 0:
INSURER E:
INSURER F :
COVERAGES CERTIFICATE NUMBER: 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 HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
TYPE OF INSURANCE
POLICY NUMBER
MM DDIYYYY
MMDDIYYYY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
PREMISES Ea occurrence)
$ 50,000
B
X COMMERCIAL GENERAL LIABILITY
X
VIGP016782
05/11J2015
05/11/2016
CLAIMS -MADE OCCUR
MED EXP (An one person)
$ 3,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER
PRODUCTS- COMPIOP AGG
$ 2,000, WO
- — —
$
PROECT- LOC
X POLICY E
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
(Ea accident)
$
ANY AUTO
BODILY INJURY (Per person)
S
_
ALL OWNED AUTOS
BODILY INJURY (Par accident)
$
SCHEDULED AUTOS
HIRED AUTOS
$
PROPERTY DAMAGE
(Per accident)
NON -OWNED AUTOS
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAR
CLAIM -MADF
DEDUCTIBLE
$
$
RETENTION $
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNER/EXECUTIVE Y 1 N
CFFICERIMEMBER EXCLUDED?
(Mandatory in NH)
NIA
4159622
03/01/2015
03/01/2016
X I WCSTATU- OTH-
TORY LIMITS ER
E L EACH ACCIDENT
$ 1,000,000
E L. DISEASE - EA EMPLOYEE
--'
$ 1,000,000
E L DISEASE - POLICY LIMIT
Is 1,000,000
f yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
City of Fort Collins is named as Additional Insured with respects to General
Liabiltiy policy.
AI19Lei-AV*w L91 4�
CITYF01
City of Ft. Collins
Jill Wuertz
P.O. Box 580
Ft. Collins, CO 80522-0580
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
(0 1988-20US ACORD CORPORATION. All rights reserved.
ACORD 25 (2009M) The ACORD name and logo are registered marks of ACORD