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HomeMy WebLinkAboutA E SERVICES LLC DBA ADAMS ELECTRIC - INSURANCE CERTIFICATEAC40RD® `..� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYY1) 4/4/2016 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 Plummer Insurance, Inc. 9732 US Hwy 26 PO BOX 548 Bridgeport NE 69336 CONTACT Luke Johnson NAME: PHOIC,NE (308)262-1200 FVC No,: (308)262-1204 ADDRESS:ljohnson@plummerinsurance.com INSURERS AFFORDING COVERAGE NAIC # INSURERA:LIBERTY MUTUAL INSURED A E Services LLC, DBA: Adams Electric 2410 W Overland Scottsbluff NE 69361 INSURER B : INSURERC:_ INSURER D : INSURER E : INSURERF: cnVFRnr.Fs CERTIFICATE NUMBER:CL164401789 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 ADDL SUBR POLICY NUMBER MM/DDY EFF POLICY MMIDD EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE �X OCCUR (17) 57213492 4/1/2016 4/1/2017 EACH OCCURRENCE $ 1,000,000 DAMA PREM SES Ea occu ence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY JE � LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY �� ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS X X NON -OWNED HIRED AUTOS AUTOS X 19 (17) 57213492 4/1/2016 4/1/2017 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) _ $ BODILY INJURY (Per accident) $ PROPERTYDAMAGE $ Medical payments $ 5,000 A X UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE (17) 57213492 4/1/2016 4/1/2017 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DIED RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A (17) 57213492 4/1/2016 4/1/2017 ER I STATUTE ERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) kitK 111'II.A I t MULVtK VNIv I.CLLA I Iv IN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Lance Murray, Risk Manager ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 Fort Collins, CO 80522-0580 AUTHORIZED REPRESENTATIVE LUKE JOHNSON/LUKE.-T— ©19B8-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) INS025 I9ntem I The ACORD name and logo are registered marks of ACORD