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Home My WebLink AboutBACKFLOW SOLUTIONS INC - INSURANCE CERTIFICATE (2)A� o® CERTIFICATE OF LIABILITY INSURANCE DATE DIY15 12/18/2015 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 terns 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 DSP Insurance Services, Inc. 1900 E. Golf Road CONTACT NAME: J Stephen Pohl A/c HONE (847) 934-6100 A No:(847) 934-6186 E-MAIL ADDRESS: Suite 650 Schaumburg IL 60173 INSURER ($) AFFORDING COVERAGE NAIC M INSURER A: Valley Fore Insurance Co. 20508 INSURED (708) 389-5600 Backflow Solutions, Inc. INSURER B: Technology Insurance Company 42376 INSURERC: Admiral Insurance Co. 24856 INSURER D: 12607 S. Laramie Ave. INSURERE: Alsip IL 60803 INSURER F COVFRAGFS CERTIFICATE NUMRER* Cart ID 17724 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 ADOL SUER POLICY NUMBER POLICY EFF MMMD POLICY EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE I -XI OCCUR 6016191751 l/l/2016 1/1/2017 AMAGE TO RENTED PREMISES Ea ocwnence $ 500,000 X MED EXP(Any one person) $ 15,000 Contractual Liab PERSONAL S ADV INJURY $ 11000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY [X] PET LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 11000,000 BODILY INJURY (Per person) $ A X ANY AUTO 6016191801 1/1/2016 1/1/2017 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident)$ NON -OWNED X HIRED AUTOS X AUTOS A X UMBRELLA UAB X OCCUR 6016191796 1/1/2016 1/l/2017 EACHOCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAR CLAIMS -MADE DIED RETENTION$ S COMPB WORKERS AND EMPLOYERS'YERS'LILIATONABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? 7 (Mandatory in NH) N/A TNC3305722 1/l/2016 1/1/2017 X STATUTE EIPERORH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 11000,000 If yes, dascnbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 11000,000 C PROF/POLL LIABILITY 3494003 1/1/2016 1/1/2017 Each Claim/ $ 2,000,000 Aggregate $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins is added as Additional Insured with respect to General Liability and Automobile Liability as required by written contract. City of Fort Collins Attn: Norman Mill PO Box 580 Fort Collins CO 80522 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 All rights reserved. ACORD 25 (2013/04) The ACORD name and logo are registered marks of ACORD