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HomeMy WebLinkAboutNOVOTNY ELECTRIC LLC - INSURANCE CERTIFICATE (8)NOVOT-1 OP ID: P5 ACORO` CERTIFICATE OF LIABILITY INSURANCE DATE 10/02/2015Y) 10/02/2015 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: House Account Brown 8 Brown Inc PHONE 970�82-7747 p� No : 970-484-4165 4532 Boardwalk Dr, Suite 200 ac No Exe Fort Collins, CO 80525 E-MAIL House Account ADDRESS: INSURERS AFFORDING COVERAGE NAIL # INSURER A: UNITED FIRE GROUP INSURED Novotny Electric LLC INSURER B : United Fire & Casualty Co. 13021 530 Ruby Drive INSURERC:Pinnacol Assurance Company 41190 Fort Collins, CO 80525 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER- REVISION NUMRFR- 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. iLT R LTR TYPE OF INSURANCE ADDL POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F—xl OCCUR 60453754 10/23/2015 10/23/2016 EACH OCCURRENCE $ 1,000,00 ENTED DAMAGEREMISES T Ea nce P occurre $ 100OO MED EXP (Any one person) $ 5100 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- ❑ JECT LOC OTHER: GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP/OPAGG $ 2,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS X NON -OWNED HIRED AUTOS AUTOS 60453764 10/23/2015 10/23/2016 COMBINED SINGLE LIMIT Ea ccident a $ 1,000,00 BODILY INJURY (Per person) $ $ BODILY INJURY (Per accident) X PROPERTY DAMAGE Peraccident $ B X UMBRELLA LIAB LIAB OCCUR CLAIMS -MADE 60453754 10/23/2015 10/23/2016 EACH OCCURRENCE $ 1,000,00 rEXCESS AGGREGATE $ 1,000,00 DIED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N 1A 177813 10/01/2015 10/01/2016 X PER R STATUTE ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEE $ 500,00 $ 500,00 E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) FAX: 970-224-6134 CITYFC2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE House Account ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD NOVOT-1 PACE 2 NOTEPAD INSURED'SNAME Novotny Electric LLC OP ID: P5 Date 10/02/2015 Policy includes broadened liability plus endorsement CG7151 02/11 provides coverage for additional insured if required by written contract: Additional insured - ongoing operations Primary -noncontributory coverage basis Waiver of subrogation Per project and per location aggregate Workers Compensation includes blanket waiver of subrogation if required by written contract - policy form 359-B