Loading...
HomeMy WebLinkAboutMEYER AND SONS ELECTRIC CO - INSURANCE CERTIFICATE (3)Policy Number: Date Entered:12/9/2015 A® C � DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/9/2015 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 endorsement(s). PRODUCER CONTACTMichael P. Ainslie Ainslie Insurance Agency, Inc. NAME: PHONE -8917 3-1014 929 38th Avenue Court, #101 Co xt : () c E-MAIL ai mPnslica e@comst.net Greeley, CO 80634-1546 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC Y INSURERA:Truck Insurance Exchange 121709 INSURED Meyer and Sons Electric Co. INSURER B Mr. Robert Meyer INSURER C : 5951 W. 26th Street INSURER D: Greeley, CO 80634 INSURER E INSURER F : CnVFRAt=FS CFRTIFIrATF NI IMRFR• RFVICIr1N NI IMRFR- T (� iIS it, TO CERTIFY 1 HAT T E POLICIES OF INSURANCE LISTED DELOIA' IiAVE BEEN ISSUED TO TI IE 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 p SUBR POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MM/DDNYYY LIMITS A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR 60299-48-65 2/13/2015 2/13/2016 EACH OCCURRENCE $ 2 , 000 , 000 DAMAGE TO RENTED PREMISES Ea occurrence 100 000 $ r MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 2 r 000 , 000 GEN'L _ AGGREGATE LIMIT APPLIES PER: ® JE PO - POLICY D LOC OTHER GENERAL AGGREGATE $ 4 , 000 , 000 PRODUCTS -COMP/OP AGG $ 4 , 000 , 000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NOTO WNED 60299-48-65 2/13/2015 2/13/2016 COMBINED SINGLE LIMIT Ea accident $ 1 000 000 r r BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTYDAMAGE Per accident $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under nGg���oTlnp; OF ,0PPP1.T!ONS b_1-,v N / A PER OTH- STATUTE I I ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POL!CYLIMIT $ li DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 1—r—K I Ir-II.A I t r1ULUtK UANUtLLA I IUN City of Fort Collins P.O. Box 580 Fort Collins, CO 80522-0580 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 i © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Plus software. www.FormsBoss.com; Impressive Publishing 800-208-1977