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HomeMy WebLinkAbout102715 HAHN PLUMBING & HEATING INC - INSURANCE CERTIFICATE (4)ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 0725/2017 I 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 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 endorsements . PRODUCER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 CONTACT NAME: CLIENT CONTACT CENTER A CNNo Ext : 888-333-4949 A/c No): 507 446 4664 E-MAIL ADDREss: CLIENTCONTACTCENTER FEDINS.COM OWATONNA, MN 55060 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 314-001-9 INSURER B: FEDERATED SERVICE INSURANCE COMPANY 28304 INSURER C: HAHN PLUMBING & HEATING INC PO BOX 1924 FORT COLLINS, CO 80522-1924 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 21 REVISION NUMBER: 0 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 ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD/YYYY LIMITS A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR BUSINESS OWNER'S LIABILITY Y N 9430480 08/31/2017 08/31/2018 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $100,000 X MED EXP (Any one person( $5,000 GEN'L �OTHER: PERSONAL & ADV INJURY $1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO ❑ LOC JECT GENERAL AGGREGATE $2,000,000 PRODUCTS - COMPIOP AGG $2,000,000 B AUTOMOBILE X LIABILITY ANY AUTO SCHEDULED OWNED AUTOS ONLY SCHEDULED AUTOS HIRED AUTOS ONLY NON -OWNED AUTOS ONLY N N 9430481 08/31/2017 08/31 /2018 COMBINED SINGLE LIMIT a Ea ccident $1,000,000 BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE N N 9430482 08/31/2017 08/31/2018 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 DED RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER STATUTE OTH- ER ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CITY OF FORT COLLINS IS NAMED AS ADDITIONAL INSURED ON THE BUSINESSOWNERS LIABILITY POLICY. f1CDTICI(14TC HP11 r1Fo CANCELLATION 314-001-9 CITY OF FORT COLLINS UTILITIES DEPARTMENT PO BOX 580 FORT COLLINS, CO 80522-0580 21 0 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 Cd 1URR_2n15 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Additional Insured Copy FEDERATED INSURANCE COMPANIES THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM SCHEDULE State Or Governmental Agency or Subdivision or Political Subdivision: CITY OF FORT COLLINS P O BOX 580 FORT COLLINS CO 80522 The following is added to Paragraph C. Who Is An Insured: 4. Any state or governmental agency or subdivision or political subdivision shown in the Schedule is also an insured, subject to the following provisions: a. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. Insured: HAHN PLUMBING & HEATING INC PO BOX 1924 FORT COLLINS CO 80522 b. This insurance does not apply to: (1) 'Bodily injury", "property damage", or "personal and advertising injury" arising out of operations performed for the state or municipality; or (2) 'Bodily injury" or "property damage" included within the "products -completed operations hazard". Place of Issue: FEDERATED MUTUAL INSURANCE COMPANY Home Office 121 East Park Square Owatonna, MN 55060 (507) 455-5200 Includes copyrighted material of Insurance Services Office, Inc., with its permission. BP-F-254 (08-11) Policy Number: 9430480 Transaction Effective Date: 08-31-2017 Additional Insured Copy FEDERATED INSURANCE COMPANIES THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM SCHEDULE State Or Governmental Agency or Subdivision or Political Subdivision: CITY OF FORT COLLINS UTILITIES DEPARTMENT PO BOX 580 FORT COLLINS CO 80522 The following is added to Paragraph C. Who Is An Insured: 4. Any state or governmental agency or subdivision or political subdivision shown in the Schedule is also an insured, subject to the following provisions: a. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. Insured: HAHN PLUMBING & HEATING INC PO BOX 1924 FORT COLLINS CO 80522 b. This insurance does not apply to: (1) 'Bodily injury", "property damage", or "personal and advertising injury" arising out of operations performed for the state or municipality; or (2) 'Bodily injury" or "property damage" included within the "products -completed operations hazard". Place of Issue: FEDERATED MUTUAL INSURANCE COMPANY Home Office 121 East Park Square Owatonna, MN 55060 (507) 455-5200 Includes copyrighted material of Insurance Services Office, Inc., with its permission. BP-F-254 (08-11) Policy Number: 9430480 Transaction Effective Date: 08-31-2017