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HomeMy WebLinkAboutSIMPSON ELECTRIC INC - INSURANCE CERTIFICATE (13)SIMPELE-01 CWATSON ACORO CERTIFICATE OF LIABILITY INSURANCE DAT D/YYYY) 2/19/219/2016 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 NAME: CT Angela Gross TrueNorth PHONE 303 776-5122 FAX 303 776-5495 PO Box 847 (A/C, No, Ext): ( ) _ (A/C, Nol: ( ) Longmont, CO 80502 ADDE-MRESS: INSURED Simpson Electric, Inc 1920 Glenview Court Berthoud, CO 80513 INSURER(S) AFFORDING COVERAGE NAIC III INSURER A: Charter Oak Fire Insurance Company 25615 INSURER B: OWnerS Insurance Company 32700 INSURERC:Travelefs Indemnity Company 25658 INSURER D : Pinnacol Assurance Company 41190 INSURER E : Zurich American Insurance Company 16535 INSURER F : COVFRAGFS CFRTIFICATF NIIMRFR- RFVISION Nl1MRFR- 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 CONTRACTOR 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 ADDL SUBR POLICY EFF POLICY EXP--- LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LABILITY EACH OCCURRENCE $ 1,000,00 _ CLAIMS -MADE X OCCUR DANIAGETO RENTED 6803299C3591642 02/20/2016 02/20/2017 i PREMISES (Ea occurrence) $ 300,00 MED EXP (Any one person_) $ 5,00 I PERSONAL & ADV INJURY I $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 E0X POLICY J_� LOG PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER. $ AUTOMOBILE LIABILITY CO BINEDt) SINGLE LIMIT $ 1,000,000 (EaB X ANY AUTO 4268565900 11/24/2015 11 /24/2016 BODILY INJURY (Per person) 1 $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident 1$ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 Is 1,000,00_ C EXCESS LIAB CLAIMS -MADE CUP8126C161 02/20/2016 02/20/2017 AGGREGATE DIED X RETENTION $ 5,000 $ WORKERS COMPENSATION X X�ERH AND EMPLOYERS' LIABILITY Y / N STATUTE D ANY PROPRIETOR/PARTNER/EXECUTIVE 4182129 04/01/2015 04/01/2016 E.L. EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED'/ ❑ NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 if yes, describe una r DESCRIPTION OF OPERATIONS below --- ----- _- E.L. DISEASE - POLICY LIMIT $ 11000,00 E Workers Compensation WC007998800 02/10/2016 04/01/2016 See DESCR OF OPS DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) WORKERS COMPENSATION - OTHER STATES COVERAGE/NEBRASKA: Employers Liability: Each Accident: $1,000,000; Policy Limit: $1,000,000; Each Employee: $1,000,000 City of Fort Collins as Additional insured with respect to General Liability per policy form. CFRTIFICATF HOI nFR CANCFI I ATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins Ty Attn: Laurie THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 580 AUTHORIZED REPRESENTATIVE 40 Fort Collins, CO 80522 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD