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HomeMy WebLinkAboutSCOTT TECHNOLOGIES OF DE INC DBA SCOTT SAFETY - INSURANCE CERTIFICATESHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME: CONTACT (A/C, No): FAX E-MAIL ADDRESS: PRODUCER (A/C, No, Ext): PHONE INSURED COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ PROPERTY DAMAGE $ BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS AUTOS AUTOS NON-OWNED HIRED AUTOS ALL OWNED SCHEDULED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED EFFECTIVE DATE: THIS CERTIFICATE OF INSURANCE WAS GENERATED AND DELIVERED BY EXIGIS RiskWorks® rm.Certificates® Marsh USA Inc. FOR QUESTIONS REGARDING THIS CERTIFICATE OF INSURANCE CONTACT: Scott Technologies of DE, Inc., DBA Scott Safety 4320 Goldmine Road Monroe, NC 28110 United States Business Process Automation for Risk Management, Insurance, and Trade Finance Gay Clontz (Email: gclontz@tycoint.com Phone: 704-291-8304) To learn what EXIGIS can do for your business visit exigis.com or call 800.928.1963 REGARDING NOTICE OF CANCELLATION TO CERTIFICATE HOLDERS: This endorsement modifies the notice of cancellation of insurance provided hereunder: Should any of the above described policies be cancelled, other than for non-payment of premium, before the expiration date thereof, 30 days advice of cancellation will be delivered to certificate holders in accordance with the policy endorsements. All other terms and conditions of this policy remain unchanged. REGARDING ADDITIONAL INSURED STATUS: In accordance with the policy provisions, City of Fort Collins is included as an additional insured under this policy, as a result of any contract or agreement entered into by the named insured and City of Fort Collins. In accordance with the policy provisions, coverage afforded to an additional insured will apply as primary insurance where required by contract entered into by the named insured and the City of Fort Collins. Any other insurance issued to such additional insured shall apply as excess and noncontributory insurance. Other Additional Insureds: officers, agents and employees and PFA (Poudre Fire Authority) REGARDING WAIVER OF SUBROGATION: In accordance with the policy provisions, the Waiver of Subrogation applies per contract or agreement entered into by the named insured and City of Fort Collins. OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT ER OTH- STATUTE PER (MM/DD/YYYY) LIMITS POLICY EXP (MM/DD/YYYY) POLICY EFF LTR TYPE OF INSURANCE POLICY NUMBER INSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB EACH OCCURRENCE $ AGGREGATE $ $ OCCUR CLAIMS-MADE DED RETENTION $ PRODUCTS - COMP/OP AGG $ GENERAL AGGREGATE $ PERSONAL & ADV INJURY $ MED EXP (Any one person) $ EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD $1,000,000.00 Scott Technologies of DE, Inc., DBA Scott Safety 4320 Goldmine Road Monroe, NC 28110 United States $2,000,000.00 WLR C48592284 (AZ, CA, MA) SCF C48592296 (WI) WLR C48592272 (All Other States) X $2,000,000.00 $2,000,000.00 A A 10/1/2015 10/1/2015 X X HDO G27400358 Project: City of Fort Collins, CO (Service Agrmt) Please refer to attached ACORD 101 for further remarks. Please see bottom of 2nd page X X OWNER'S & CONTRACTOR'S PROT X $250,000.00 A X B C Marsh USA Inc. 1166 Avenue of the Americas New York, NY 10036 10/1/2016 10/1/2016 City of Fort Collins Attn: Purchasing Dept P. O. Box 580 215 North Mason Street Fort Collins, Colorado 80524 United States X X 10/1/2015 10/1/2015 10/1/2015 $2,000,000.00 NEW HAMPSHIRE (CSL) 5/3/2016 22667 20702 43575 MARSH USA INC, BY: Matthew Ferry, Casualty Program PRODUCTS - Cindy Stathos, Michael Stastny or Terryn Castanon INSURER A: ACE American Insurance Company INSURER B: ACE Fire Underwriters Insurance Company INSURER C: Indemnity Insurance Company of North America $2,000,000.00 X $1,000,000.00 X 1534728 - A 10/1/2016 10/1/2016 10/1/2016 ISA H08859905 (Excludes NH) ISA H08859917 (NH) $10,000.00 N $1,000,000.00 10/1/2016 X A (844) 892-0092 $1,000,000.00 10/1/2015