Loading...
HomeMy WebLinkAbout473287 SHORT-ELLIOTT-HENDRICKSON INC - INSURANCE CERTIFICATE (12)ACORDDATE (MM/DDlYYYY) M CERTIFICATE OF LIABILITY INSURANCE 09/24/2015 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 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 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: H. Robert Anderson & Assocs., Inc. PHONE 952.893.1933 FAX AIC NoE# acN,:952.893.1819 8201 Norman Center Drive ADDREss: Suite 220 IN AFFORDING COVERAGE NAIC # Bloomington, MN 55437 INSURER A: XL Specialty Insurance Co. INSURED Short -Elliott -Hendrickson, Incorporated INSURERB: 3535 Vadnais Center Drive INSURERC: St. Paul, MN 55110 INSURER D : INSURER E INSURER F : rr)VFRAr;FS CFRTIFICATF NUMBER. 2015 - 2016 1 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. I SRTYPE LTR OF INSURANCE INSR WVD POLICY NUMBER i'MIDDr EFF MMIDD/YYYY I POD X I MMlDDlYYYY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS-MADE11 OCCUR EACH OCCURRENCE $ PREMISES(Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY nPRO- LOC JECT PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS (Ea accident) $ $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PROPER DAMAGE Per accident) $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE[— OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A - - TORY LIMITS ER E.L. EACH ACCIDENT $ - $ $ E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT A Professional Liability DPR972656110/01/2015 10/01/2016 Each Claim/ $5,000,000 Annual Aggregate $10,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) This certificate or memorandum of insurance does not affirmatively or negatively amend, extend, or alter the coverage afforded by the insurance policy. CERTIFICATE HOLDER CANCELLATION City of Fort Collins 300 LaPorte Ave Fort Collins, MN 80521 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 /� I'/ t719RR-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ACORD AGENCY CUSTOMER ID: 00001137 LOC #: ADDITIONAL REMARKS SCHEDULE Page of AGENCY H. Robert Anderson & Assocs., Inc. NAMED INSURED Short -Elliott -Hendrickson, Incorporated St. Paul, MN 55110 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: ACORD Certificate of Liability Insurance CERTIFICATE HOLDER: City of Fort Collins Garage Liability INSR ADD'L SUBR POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD WVD POLICY NUMBER DATE (MM/DD/YY) DATE (MMIDDIYY) LIMITS AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ Automobile Liability Excess/Umbrella Liability POLICY EFFECTIVE POLICY EXPIRATION POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) POLICY EFFECTIVE POLICY EXPIRATION POLICY NUMBER DATE (MM/DD/YY) DATE (MMIDD/YY) LIMITS ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD