HomeMy WebLinkAbout102630 AYRES ASSOCIATES INC - INSURANCE CERTIFICATE (8)Ac"REP
v ^ CERTIFICATE OF LIABILITY INSURANCE
DATE (NQ IIDDIYYYY)
12/21/2015
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 endorsements .
PRODUCER
Arthur J. Gallagher Risk Management Services, Inc.
17035 W Wisconsin Ave., Suite 135
Brookfield WI 53005
CONTACT
NAME: Sharon Bannach
PHONE 262-792-2214 FA t 262-792-1712
E-MAIL
SS, Sharon_Bannach@ajg.com
INSURERS) AFFORDING COVERAGE
NAIC M
INSURER A: Travelers Property Casualty Co of A
25674
INSURED AYREASS-02
INSURER B:Travelers Indemnity Co of America
25666
INSURER c:The Travelers Indemnity Company of
25682
AYRES ASSOCIATES INC
PO BOX 1590
EAU CLAIRE, WI 54702-1590
INSURER D:
INSURER E :
INSURER F: _
CrTt/FRAf:FC r:FRTIFICATF NIIMRFP- 1844083967 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.
INSR
LTR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
POLICY EFF
MMIDDN YY
POUCY EXP
MMIDDNYYY
LIMITS
B
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE X� OCCUR
Y
P6302183P260TIA16
1/1/2016
1/1/2017
EACH OCCURRENCE
E1,000,000
PREMISES Ea occurrence
$100,000
MED EXP (Anyone person)
E 10,000
PERSONAL & ADV INJURY
$1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY nXJE0 LOC
OTHER:
GENERALAGGREGATE
$2,000,000
PRODUCTS - COMP/OPAGG
$2,000,000
E
A
AUTOMOBILE LIABILITY
ANY AUTO EEpp
AUTOWNED AUTOSULED
HIRED AUTOS X NON -OWNED
AUTOS
IX
Y
P810379OP125TIL16
1/1/2016
1/1/2017
COMBINED
$1,000,000
BODILY INJURY (Per person)
E
BODILY INJURY(Par accident)
E
Per accident
E
E
A
X
I UMBRELLA LIAB
EXCESS LIAB
X OCCUR
CLAIMS -MADE
PSMCUP379OP149TIL16
1/1/2016
1/1/2017
EACH OCCURRENCE
$5,000,000
AGGREGATE
$5,000,000
DED IX I RETENTIONEO
E
A
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE F
OFFICERIMEMBER EXCLUDED?
(Mandatoryin NH) -- - — - - -
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
-
PJUB2528P88116(AOS)
PEUB2522P94416(FL&WI)
1/1/2016
1/1/2016
_
1/1/2017
1/1/2017
X PERTU EORH
E.L. EACH ACCIDENT
$500,000
E.L. DISEASE - EA EMPLOYE
-
$500,000
E.L. DISEASE - POLICY LIMIT
$500,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached Ir mare space is required)
As respects 5-year open end contract agreement, City of Fort Collins, Colorado is included as an Additional Insured under the General
Liability and Auto Policies.
CFRTIFICATF HOLDER CANCELLATION
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 80522-0580
I
-AUTHORIZED REPRESENT THE 4
i s�1hc<. VVII
0 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD