Loading...
HomeMy WebLinkAbout263373 ELECTRONIC SYSTEMS INTERNATIONAL INC - INSURANCE CERTIFICATE (7)ELECT-1 OP ID: SG ACVRO CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/29/2015 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 Phone: 719-590-9990 CONTACT NAME: Suzanne Storm Six &Geving Insurance, Inc. Fax: 719-590-9992 3630 Sinton Road, Suite 200 Colorado Springs, CO 80907-5034 PHONE 719-590-9990 aC No : 719-590-9992 ac No Exc: E-MAIL DRESS: sstorm@six-geving.com Randy Geving INSURERS AFFORDING COVERAGE NAIC # INSURER A: Colony Insurance Company INSURED Electronic Systems INSURER B: Pinnacol Assurance 41190 International, Inc. 3010 Mallard Drive INSURER C : Acuity 14184 Colorado Springs, CO 80910-2247 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 2 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 DL SUER POLICY NUMBER EFF MM D/Y DYYY CY EXP YYY MMIPOLICY D DIY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1 OCCUR X 103GL0001664-02 01/01/2016 01/01/2017 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,00 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC PRODUCTS - COMP/OP AGG $ 3,000,00 $ C AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS X L75688 01/01/2016 01/01/2017 COMBINED SINGLE LIMIT Ea accident 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (Per PROPERTYDAMAGE $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If es, describe under DESCRIPTION OF OPERATIONS below N / A 4076606 01/01/2016 01/01/2017 WC STATU- OH - X T R LIMI ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) RE: City of Ft. Collins is hereby added as additional insured with regards general liability & automobile liability coverage per written contract. t;tKIIt-IGAItMULUtK %,AM r_LLHIIVIV CITYF-2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ft. Collins ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 580 Ft. Collins, CO 80522-0580 AUTHORIZED REPRESENTATIVE I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD