HomeMy WebLinkAboutTRINITY STRUCTURAL COMPONENTS LLC - INSURANCE CERTIFICATEAC")?" CERTIFICATE OF LIABILITY INSURANCE
6/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
MHBT, a Marsh & McLennan Agency, LLC company
8144 Walnut Hill Lane, 16th Floor
Dallas TX 75231
CONTACT
NAME:
PHONE g72 770-1600 FAX(AM 972 770-1699
E-MAIL
Annopq1z.
INSURERS AFFORDING COVERAGE
NAIC R
INSURER A :ACE American Insurance Company
22667
INSURED TRINIINDI
INSURER B :
INSURER C :
Trinity Structural Components, LLC
P O Box 568887
Dallas, TX 75356-8887
INSURER D
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER. 635682432 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
INSD
WVD
POLICY NUMBER
POLICY EFF
MM/DDIYYYY
POLICY EXP
MM/DD/YYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
HDOG27868186
7/1/2017
7/1/2018
EACH OCCURRENCE
$5,000,000
CLAIMS -MADE X OCCUR
DAMAGE TO RENTED
PREMISES Ea occurrence
$50,000
MED EXP (Any one person)
$10,000
PERSONAL & ADV INJURY
$5,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$7,000,000
PRODUCTS - COMP/OP AGG
$7,000,000
X POLICY PRO ❑
JECT LOC
$
OTHER:
A
A
AUTOMOBILE LIABILITY
X ANY AUTO
ISAH09060777
ISAH09060789
7/1/2017
7/1/2017
7/1/2018
7/1/2018
MIN
Ea accident
$5,000,000
BODILY INJURY (Per person)
$
ALL OS OWNED SCHEDULED
UT
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
NON -OWNED
X HIRED AUTOS N AUTOS
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LAB
CLAIMS -MADE
DED I I RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE —
OFFICER/MEMBER EXCLUDED? N
(Mandatory In NH)
N / A
WLRC64413004
7/1/2017
7/1/2018
X TE STATUTE ERH
USL&H
E.L. EACH ACCIDENT
$2,000,000
E.L. DISEASE - EA EMPLOYEd
$2,000,000
E.L. DISEASE - POLICY LIMIT
1 $2,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
Certificate Holder includes: City of Fort Collins, its officers, agents and employees
The General Liability policy includes a blanket additional insured endorsement to the certificate holder only when there is a written contract
between the named insured and the certificate holder that requires such status.
The Automobile Liability policy contains language that provides additional insured status to the certificate holder only when there is a written
contract between the named insured and the certificate holder that requires such status.
CERTIFICATE HOLDER CANCELLATION
City of Fort Collins
Attn: Purchasing
P 0 Box 580
Fort Collins CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
(9) lyt$tf-ZUT4 AI,UKU I,UKYUKAI IUIV. All rlgnis reserveo.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD