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HomeMy WebLinkAboutTUV RHEINLAND OF NORTH AMERICA INC - INSURANCE CERTIFICATETUVRHEI-03 SSWENSON ,4i` CERTIFICATE OF LIABILITY INSURANCE �� DATE 12/23/2015Y) 12/23/2015 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 Rose & Kiernan, Inc. Lee Farm Corporate Park 83 Wooster Heights Danbury, CT 06810 CONTACT NAME: PHONE FAX A/c No Exc : (203) 702-4700 Arc No ; (203) 702-4759 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Allianz Global Risks US Insurance Company 35300 INSURED INSURER B: Travelers Property Casualty Company of America 25674 INSURERC: TUV Rheinland North America Holding, Inc. INSURER D : 1300 Massachusetts Ave Ste 103 BOXborough, MA 01719 INSURER E : INSURER F COVERAGES 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. ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM DD/YYYY MM/DDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR CGL 2006347 01/01/2016 01/01/2017 EACH OCCURRENCE $ 1,000,000 AMA PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ JE� u LOC OTHER: GENERAL AGGREGATE $ 2,000,000 X PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS P8103343P614TIL16 01/01/2016 01/01/2017 COMBINED SINGLE LIMIT Ea accident)$ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE ULA 2006348 01/01/2016 01/01/2017 EACH OCCURRENCE Is 5,000,000 AGGREGATE $ 5,000,000 DED I X I RETENTION $ 330,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORlPARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A PJUB328OP50616 01/01/2016 01/01/2017 I X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEEI $ 1,000,000 E.L. DISEASE -POLICY LIMIT 1 $ 1,000,000 A Professional Liabili PPL 2006349 01/01/2016 01/01/2017 Occurrence/Aggregate 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 'City of Fort Collins as an additional insured with respects to General Liability and Automobile Liability but only as required by written agreement. CERTIFICATE HOLDER CANCELLATION City of Fort Collins 215 N Mason St, 2nd Floor P.O. Box 580 Fort Collins, CO 80525 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD TUVRHEI-03 SSWENSON .4CORO `,�,, CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 12/23/2015 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 Rose & Kiernan, Inc. Lee Farm Corporate Park 83 Wooster Heights Danbury, CT 06810 CONTACT NAME: PHONE FAX Arc No Ext : (203) 702-4700 A/c No): (203) 702-4759 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Allianz Global Risks US Insurance Company 35300 INSURED INSURER B: Travelers Property Casualty Company of America 25674 INSURERC: TUV Rheinland North America Holding, Inc. INSURER D: 1300 Massachusetts Ave Ste 103 BOXborough, MA 01719 INSURER E INSURER F COVERAGES 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 LTR TYPE OF INSURANCE AODL INSD U R WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR CGL2006347 01/01/2016 01/01/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Eaoccurzence $ 100,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. POLICY PE� LOC OTHER: GENERAL AGGREGATE $ 2,000,000 X PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS P8103343P614TIL16 01/01/2016 01/01/2017 CEa accidOMentBINED SINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ A X UMBRELLA UAB EXCESS LIAB X OCCUR CLAIMS -MADE ULA 2006348 01/01/2016 01/01/2017 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 6,000,000 DED I X I RETENTION $ 330,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) -- If yes, describe under DESCRIPTION OF OPERATIONS below N / A PJUB3280P50616 01/01/2016 01/01/2017 X PER OTH- 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 A Professional Liabili PPL 2006349 01/01/2016 01/01/2017 Occurrence/Aggregate 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project: 7218 ISO 14001 Audit Services The City of Fort Collins, its officers and employees as an additional insured with respect to General Liability but only as required by written contract/agreement. C:tK I It-IUA I t HULUtK UANL;tLLA I IUN The City of Fort Collins Purchasing Division PO Box 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE (� � /+7 � ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD