HomeMy WebLinkAboutCOGENT INC - INSURANCE CERTIFICATE (5)ACOR" CERTIFICATE OF LIABILITY INSURANCE
11111./
DATE(MM/DD/YYYY)
1 12/14/2015
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
TRUSS
4551 W. 107th St., Third Floor
Overland Park KS 66207
CONTACT Certificate Department
PHONE 913.341.8998 FAX WC No,.913.491.6379
E-MAIL . Certificates TrussAdvanta e.com
@ 9
INSURERS AFFORDING COVERAGE
NAIC If
INSURER A: United Fire & Casualty Company
13021
INSURED COGEN01
INSURERB:Mldwest Builders' Cas Mutual
13126
Cogent, Inc., Lee Mathews, BRI, Vandevanter
Engineering, Vanco and Water Technology Group,
iME Solutions
INSURERC:Maxum Indemnity Co
26743
INSURER D:
INSURER E:
318 Broadway St.
Kansas City MO 64105
INSURER F:
COVFRAGFS CFRTIFICATF tJI IMRFR• 807137536 ocvlclnM MI Molco.
"I HIS 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
rypE OF INSURANCE
INSD
WVD
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MM/DD/YYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
Y
60424257
12/31/2015
12/31/2016
EACH OCCURRENCE
$1,000,000
CLAIMS -MADE 51 OCCUR
AMA RENTED
PREMISES Ea occurrence
$100.000
MED EXP (Anyone person)
$5,000
PERSONAL B ADV INJURY
$1,000,000
GEN'L
AGGREGATE LIMIT APPLIES PER:
ElPRO-
GENERAL AGGREGATE
$2,000,000
POLICY JECT LOC
PRODUCTS - COMP/OP AGG
$2,000,000
$
OTHER:
A
AUTOMOBILE
LIABILITY
Y
60424257
12/31/2015
12/31/2016
I L LIMI
Ea accident
$ 1,000,000
X
BODILY INJURY (Per person)
$
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY Per accident)
( )
$
HIRED AUTOS NON -OWNED
AUTOS
PROPERTY DAMAGE
Per accident
$
$
A
X
UMBRELLA LIAB
X
OCCUR
60424257
12/31/2015
12/31/2016
EACH OCCURRENCE
$10,000,000
AGGREGATE
$10,000,000
EXCESS LIAB
CLAIMS -MADE
DIED I X RETENTION$-0-
$
B
WORKERS
AND EMPLO ERSELInBI m YIN
ANY PROPRIETOR/PARTNEWEXECUTIVE
OFFICER/MEMBER EXCLUDED? NI
N / A
166WC1076
1/1/2016
1/1/2017
X STATUTE EORH
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE - EA EMPLOYE
$1,000.000
(Mandatory in NH)
If yes, describe under
_ _ _ _
E.L. DISEASE - POLICY LIMIT 1
$1,000,000
DESCRIPTION OF OPERATIONS below
C
Professional Liability
PFP6021408-03
12/31/2015
12/31/2016
Limit 2,000,000
DESCRIPTION OF OPERATIONS f LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
The insurance evidenced by this Certificate will not reduce coverage or limits and will not be cancelled, except after thirty (30) days written
notice has been received by the City of Fort Collins.
City of Fort Collins, CO
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
16"
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ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD