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HomeMy WebLinkAbout520431 SCHEIDT & BACHMANN USA INC - INSURANCE CERTIFICATE (3)ACORN® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/31/2015 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 Aon Risk Services Northeast, Inc. Boston MA Office CONTACT NAME: PHONE (866) 283-7122 FAX 800-363-0105 (A/C. No. Ezt): (A/C. No.): E-MAIL ADDRESS: One Federal Street Boston MA 02110 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED 2- Scheidt & Bachmann USA Inc �C 31 North Avenue Burlington MA 01803 USA INSURER A: Travelers Casualty&Surety Co of America 31194 INSURERB: The Travelers Indemnity Co. 25658 INSURERC: Travelers Property Cas Co of America 25674 INSURER D: XL Insurance America Inc 24554 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570060817353 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE IN INSD SU R WVD POLICY NUMBER POLICY EF MM/DD/YYYY POLICY MM/DD/YYYY LIMITS D X COMMERCIAL GENERAL LIABILITY US LI A / 1 011011201 EACH OCCURRENCE $1,000,000 CLAIMS -MADE OCCUR DAMA N PREMISES Ea occurrence) $lOO,000 X MED EXP (Any one person) $10 , 000 Per Occ Ded $15000 PERSONAL &ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY ❑ PRO ❑ JECT LOC PRODUCTS - COMP/OP AGG $2,000,000 OTHER: Emp Benefits Per Claim $1,000,000 C AUTOMOBILE LIABILITY 810-9199C532 ADS 01/01/2016 01/01/2017 COMBINED SINGLE LIMIT Ea accident)$ S00 , 000 BODILY INJURY ( Per person) X ANY AUTO ALL OWNED SCHEDULED BODILY INJURY (Per accident) AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident Comp/Coll Deductible $1, 000 UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LAB CLAIMS -MADE AGGREGATE DED RETENTION B COMPENSATION AND WORKERS LIABILITY YIN ANY PROPRIETOR/ PARTNER/ EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) N / A UB8427c676 01/01/2016 01/01/2017 X EOH STATUTE R E.L. EACH ACCIDENT $100, 000 E.L. DISEASE -EA EMPLOYEE $100 , 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 500 , 000 A D&O-Primary 105721S10 12/20/2015 12/20/2016 Each Loss Limit $2,000,000 SIR applies per policy terins & condi ions Retention $50,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins is included as additional with respect to the general liability policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins AUTHORIZED REPRESENTATIVE 215 North Mason Street, 2nd Floor Fort Collins Co 80524 USA JV. (??rDfC �riLtt�eseD c/1aLtt �n� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 10603646 LOC #: ® ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk Services Northeast, Inc. NAMED INSURED Scheidt & Bachmann USA Inc POLICY NUMBER See Certificate Number: 570060817353 CARRIER See Certificate Number: 570060817353 NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/Y POLICY EXPIRATION DATE (MMJDD/YYYY) LIMITS GENERAL LIABILITY D Us00010045LI16A 01/01/2016 01/01/2017 Emp Benefits Aggregate $1,000,000 Emp Benefits Deduct. $15,000 ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD