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Home My WebLink AboutWAYNE'S ELECTRIC INC - INSURANCE CERTIFICATEACoR" CERTIFICATE OF LIABILITY INSURANCE 3/DATE(M I D/YYYY) 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 endorsements . PRODUCER NAME:CONTAHeather Wilt CIC Keller Lowry a Buckner Company PHONE Fax -- 1777 S Harrison St #700 WC. Nn,�)_ 303-756-9909 303-756-8818 E-MAIL Heather@kellerlowry.com Denver CO 80210 -S; ry•com ADDS INSURED Wayne's Electric Inc. 2101 Weld County Road 27 Fort Lupton CO 80621 2447 Allied Group/Nationwide Mutual Pinnacol Assurance CAVFRAnFA RFRTIFIRATF IUI IMC2GR• 549335494 OCVIQIAAI w11 IMOCO. 190 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 TYPE OF INSURANCE �a POLICY EFF POLICY EXP LTR INSO WVD POLICY NUMBER MM/DD/YYYY) IMMIDD/YYYYJ LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X❑ OCCUR ACP3026566899 4/1/2016 ' 4/1/2017 EACH OCCURRENCE $1,000,000 TO ES(RENTED PREMISES occurrence) $100,ODD MED EXP (Any one person) $5, 000 PERSONAL & ADV INJURY $1,000,000 GEN'L %( AGGREGATE LIMIT APPLIES PER: POLICY ❑ JET LOC OTHER GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS ACP3026566899 4/1/2016 4/1/2017 COMBINED SINGLE LIMIT a accident $ 1,000,D00 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident ) $ X PROPERTY AMAGIE (Per accident $ S A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE ACP3026566899 4/1/2016 4/1/2017 EACH OCCURRENCE $10,000,000 AGGREGATE $10,000,000 DED RETENTION $ $ g WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICEWMEMBER EXCLUDED? ❑N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 4055318 4/1/2016 4/1/2017 X PER OTH- STATUTE ER El. EACH ACCIDENT _ $1,000,000 $1,000,000 - -- $1,000,000 E.L. DISEASE - EA EMPLOYEE E.L. DISEASE -POLICY LIMIT i I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION City of Fort Collins P O Box 580 Fort Collins CO 805220580 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 O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014/01) The ACORD name and logo are registered marks of ACORD