HomeMy WebLinkAbout473287 SHORT-ELLIIOTT-HENDRICKSON INC - INSURANCE CERTIFICATE�°111 CERTIFICATE OF LIABILITY INSURANCE DAT10/5 0 5 Y)
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 NAMECT Tony Blaisdell
Commercial Lines - 952-242-3100 -- -
PHCC. No.
E 952-242-3131 _ (AR, NOI:
Wells Fargo Insurance Services USA, Inc. nDORIEs tony.blaisdell@wellsfargo.com
400 Highway 169 South - INSURER(S) AFFORDING COVERAGE NAIC $
St. Louis Park, MN 55426 INSURER A: Hartford Casualty Insurance Company 29424
INSURED INSURERB: Depositors Insurance Company 42587
Short -Elliott -Hendrickson, Inc. INSURERC: Continental Casualty Company 20443
5 Vadnais Center Drive
INSURERD: Twin City Fire Insurance Company 29459
St. Paul, MN 55110 INSURERE:
COVERAGES CERTIFICATE NUMBER- 9650577 RFVI--CIf1N NII IMRFR• Coo h.1—
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.
INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP
LTR POLICY NUMBER MM/DD/YYYY) (MM/DD/YYYYI LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
X
CLAIMS -MADE OCCUR
41UENQT9743
This is a revision of any
10/01/15
10/01/16
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES (Ea occurrence
$ 300,000
MED EXP (Any one person)
$ 10,000
- ---- -
previous certificates
PERSONAL & ADV INJURY
$ 1,000,000
issued on 9.30.15
AGGREGATE LIMIT APPLIES PER:
POLICY I " 1 PECOT- C] LOC
GENERAL AGGREGATE
$ 2,000,000
GEN'L
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
OTHER:
B
AUTOMOBILE
LIABILITY
BAPD 7101965099
10/01/15
10/01/16
COMBINED SINGLE LIMIT
Ea accident
$ 1.000,000
BODILY INJURY (Par person)
$
X
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
INJURY BODILY INJPer accident
( )
$
X NON -OWNED
HIRED AUTOS AUTOS
X
PROPERTY DAMAGE
Per accident)
$
C
X
UMBRELLA LIAB
X
OCCUR
L6011730036
10/01/15
10/01/16
EACH OCCURRENCE
$ 7.000,000
AGGREGATE
$ 7,000,000
EXCESS LIAR
CLAIMS -MADE
DED I X I RETENTION $ 10,000
$
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑N
N /A
41WEQT9807
10/01/15
10/01/16
PER OTH
X STATUTE ER
_
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000.000
I i
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
Certificate Holder is Additional Insured with regards to General Liability when required by written contract.
ULKIIFIGATE HOLDER CANCELLATION
City of Fort Collins
300 La Porte Avenue
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
The ACORD name and logo are registered marks of ACORD @ 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) 111111111111111111 IN 11111111111111111111111111111111111111111111111111111111111111111111 -CYBOIA05/000926/02/02/0/01010*1111-CYBOIA05/000926/oti0vo/010/0•