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HomeMy WebLinkAboutSIMPSON ELECTRIC INC - INSURANCE CERTIFICATE (14)SIMPELE-01 MATSON ACORO DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 3/18/2016 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 CONTACT NAME: Angela Gross TrueNorth PHONE FAX PO BOX 847 AIC No Et): (303) 776-5122 o): 303 776-5495_ , (A/C, N Longmont, CO 80502 A DRESS: INSURED Simpson Electric, Inc 1920 Glenview Court Berthoud, CO 80513 COVERAGES INSURER(S) AFFORDING COVERAGE NAIC # _ INSURER A: Charter Oak Fire Insurance Company 25616 INSURERS: Owners Insurance Company 32700 INSURERC:Travelers Indemnity Company 26658 INSURER D : Pinnacol Assurance Company 41190 INSURER E: Zurich American Insurance Company 16535 INSURER F : CERTIFICATE NUMBER: 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 - ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD MMMDIYYW LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X 02/20/2017 DAMAGE TORENT 300 CLAIMS -MADE � occuR 6803299C359 02/20/2016 PREMISES (Ea occurrenceE ,00 MED EXP (Any one person) $ 5,00 PERSONAL& ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 X. POLICY F] JEC LOC PRODUCTS-COMP/OPAGG s 2,000,000 AUTOMOBILE LIABILITY B X ANY AUTO ALL OWNED - SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS X UMBRELLA LIAR A OCCUR C EXCESS LIAB rACLAWS-MADE' DED X ; RETENTION $ 5,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N D ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? NIA (Mandatoryin NH) If yes, describe under DESCRIPTION OF OPERATIONS below E Workers Compensation s COMBINEDSINGLE LIMIT $ 1 (Ea accident) 4268565900 11/24/2015 11/24/2016 BODILY INJURY (Per person) $ i I BODILY INJURY (Per accident) $ CUP8126C161 4182129 WC007998801 PROPERTY DAMAGE $ Per accident EACH OCCURRENCE $ 1,000,000 02/20/2016 02/20/2017 1 AGGREGATE I $ 1 X STATUTE X 04/01/2016 04/01/2017 E.L. EACH ACCIDENT $ 1 E.L.DISEASE -EA EMPLOYEE $ 1 E.L. DISEASE - POLICY LIMIT $ 1 04/01/2016 04/01/2017 See DESCR OF OPS DESCRIPTION OF OPERATIONS I LOCATIONS I 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 HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Laurie P.O. Box 580 AUTHORIZED REPRESENTATIVE &OV—DINA-w" 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