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HomeMy WebLinkAboutTEPA LLC - INSURANCE CERTIFICATEA`C�OR�►® CERTIFICATE OF LIABILITY INSURANCE DATE (YYYY) 3/8/2018/2016 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 Ileu of such endorsement(s). PRODUCER Commercial Lines - (800)-332-9256 Wells Fargo Insurance Services USA, Inc. CONTACT Theresa Becker NAME: PHONE 303-863-6677 Fn//C Na ; 877-405-9032 E-MAIL theresa.m.ecer wesar bklifo.com ADDRESS: @ g 90 S. Cascade Ave, 2nd Floor _ INSURERS AFFORDING COVERAGE NAIC # Colorado Springs, CO 80903 INSURERA: Old Republic Insurance Company 24147 INSURED INSURER B : Travelers Property Casualty Co of America 25674 Tepa, LLC INSURER C 5045 List Drive INSURER D INSURER E Colorado Springs, CO 80919 INSURER F COVERAGES CERTIFICATE NUMBER: 10232305 REVISION NUMBER: See below 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, ILT R' TYPE OF INSURANCE LTR POLICY NUMBER POLICY EYY) IMOLPOLICY EXP MM/DDIYYYY � MM/DDlYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR MWZY303868 3/1/2016 3/1/2017 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 500,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X ,, JE � 7 LOC OTHER GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED i HIRED AUTOS x W AUTOS MWTB303867 3/1/2016 3/1/2017 COMBINED SINGLE LIMIT a accident g 1,000,000 X BODILY INJURY (Per person) $ 5.000 BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per axid nt $ B x UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE ZUP-14T80862-15-NF 3/1/2016 3/1/2017 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5.000,000 DED X RETENTION $ 10,000 Is A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR'PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? FN] (Mandatory in NH) If Yes describe under DESCRIPTION OF OPERATIONS below N / A MWC30386600 3/1/2016 3/1/2017 PER OTH- X STATUTE ER E.L. EACH ACCIDENT _ $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 B Installation Leased/Rented Equipment 660367M779ATIL15 3/1/2016 3/1/2017 $250,000 $250,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Certificate holder is recognized as an additional insured as respects: Contractors License fax:970-224-6134 CEK 1 IhICA 1 E HULUEK CANCELLATION City of Ft. Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O. Box 580 ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins CO 805220580 AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) 111111111111111111111111111111111 IN 11111111111111111111111111111111111111111111111111111 CYBOlAO81001104/02/02/010/010'