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HomeMy WebLinkAbout105888 VALMONT INDUSTRIES - INSURANCE CERTIFICATE (3)Holder Identifier : 7777777707070700077761616045571110767717016204447207442027772507300072640577046230130777451517127444707177154633671103071732374631777210763151027046221207360011570036530076727242035772000777777707000707007 7777777707070700073525677115456000733001517136102107033336353073100070333362530621100703323624206311007022226353063011070232272531720000702222634307311007123337243062110077756163351765540777777707000707007 Certificate No : 570065081998 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/30/2016 IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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). 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. PRODUCER Aon Risk Services Central, Inc. Omaha NE Office 11213 Davenport Suite 201 Omaha NE 68154 USA PHONE (A/C. No. Ext): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # (402) 697-1400 INSURED INSURER A: ACE American Insurance Company 22667 INSURER B: Evanston Insurance Company 35378 INSURER C: The Continental Insurance Company 35289 INSURER D: INSURER E: INSURER F: FAX (A/C. No.): (402) 697-1594 CONTACT NAME: Valmont Industries, Inc. Attn: Megan Wagner One Valmont Plaza Omaha NE 68154-5215 USA COVERAGES CERTIFICATE NUMBER: 570065081998 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. Limits shown are as requested POLICY EXP (MM/DD/YYYY) POLICY EFF (MM/DD/YYYY) SUBR WVD INSR LTR ADDL TYPE OF INSURANCE INSD POLICY NUMBER LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR POLICY LOC EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) Named Insured Schedule AGENCY THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance ADDITIONAL REMARKS EFFECTIVE DATE: CARRIER NAIC CODE NAMED INSURED See Certificate Number: See Certificate Number: POLICY NUMBER AGENCY CUSTOMER ID: ADDITIONAL REMARKS SCHEDULE LOC #: 10576471 Aon Risk Services Central, Inc. 570065081998 570065081998 Page _ of _ Valmont Industries, Inc. Valmont Industries, Inc. AgSense, LLC George Industries, Inc. Valmont - Southeastern Galvanizing, Inc. Valmont - Virginia Galvanizing, Inc. Valmont - Columbia Galvanizing, Inc. Valmont - Birmingham Galvanizing, Inc. Industrial Galvanizers America Holdings, Inc. Industrial Galvanizers America, Inc. Matco Services, Inc. Pirod, Inc. (De) Valmont Coatings, Inc. (De) Valmont International Corp. Valmont Newmark, Inc. Valmont Northwest, Inc. Valmont Composite Structures, Inc. Valmont Service Centers, Inc. American Galvanizing Compnay, Inc. Valley Exports, Inc. Cascade Earth Sciences Ltd. (Umbrella Only) Pure Metals Galvanizing ULC (Umbrella Only) Lampadaires Feralux, Inc. (Umbrella Only) Valmont West Coast Engineering Ltd. (Umbrella Only) Valmont WC Engineering Group Ltd. (Umbrella Only) Valmont West Coast Engineering, Inc. ( Umbrella Only) ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG X X X GEN'L AGGREGATE LIMIT APPLIES PER: $2,000,000 $1,000,000 $10,000 $1,000,000 $4,000,000 $4,000,000 A 01/01/2017 01/01/2018 General Liability HDOG27861556 PRO- JECT OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY SCHEDULED AUTOS HIRED AUTOS ONLY NON-OWNED AUTOS ONLY BODILY INJURY ( Per person) PROPERTY DAMAGE (Per accident) X BODILY INJURY (Per accident) A $2,000,000 01/01/2017 01/01/2018 SIR applies per policy terms & conditions COMBINED SINGLE LIMIT (Ea accident) ISAH09053694 EXCESS LIAB X OCCUR CLAIMS-MADE AGGREGATE EACH OCCURRENCE DED $10,000,000 $10,000,000 $10,000 01/01/2017 Umbrella C UMBRELLA LIAB 5094882742 01/01/2018 X RETENTION X E.L. DISEASE-EA EMPLOYEE E.L. DISEASE-POLICY LIMIT E.L. EACH ACCIDENT $1,000,000 X OTH- ER PER STATUTE A 01/01/2017 01/01/2018 WC $1,000,000 Y / N (Mandatory in NH) ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED? N N / A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY If yes, describe under DESCRIPTION OF OPERATIONS below $1,000,000 WLRC49109313 MKLV7PL0002539 01/01/2017 03/01/2018 Each Claim A&EProfessional Liability Aggregate $5,000,000 Retention $500,000 B Archit&Eng Prof $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Additional Insured - The General Liability and Automobile Liability policies include a blanket automatic additional insured endorsement or policy terms that provide additional insured status to certificate holder including the "products-completed operations" hazard where required by written contract. Waiver of Subrogation - All policies listed above include a blanket automatic waiver subrogation endorsement or policy terms that provide a waiver of subrogation only where required by written contract. Loss Payee - Automobile Liability policy includes a blanket loss payee endorsement or policy terms that provide loss payee status to certificate holder where required by written contract. Coverage is primary and non contributory. Umbrella policy follows form of underlying policies listed above. CERTIFICATE HOLDER CANCELLATION City of Fort Collins AUTHORIZED REPRESENTATIVE Financial Services; Purchasing Division 215 N. Mason Street 2nd Floor Po Box 580 Fort Collinsq CO 80522 USA ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.