HomeMy WebLinkAboutTRANSDEV ON-DEMAND INC - INSURANCE CERTIFICATE (3)A CNZhP
`(`� CERTIFICATE OF LIABILITY INSURANCE
ATE (MM/DD/YYYY)
06/20/2018
r
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 endorsement(s).
PRODUCER
CONTACT Dana Stewart, CIC, CISR
NAME:
Flood and Peterson
n/oNNo Ext : (970) 266-7149 A/X F C No): (970) 506-6845
E-MAIL DStewart@floodpeterson.com
ADDRESS:
PO Box 578
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURERA: Charter Oak Fire Insurance Company
25615
Greeley CO 80632
INSURED
INSURER B: Travelers Property Casualty Company of America
25674
INSURER C : Pinnacol Assurance
41190
Gregory Electric, Inc.
INSURER D :
3317 N. Lincoln Ave.
INSURER E :
INSURER F :
Loveland CO 80539
COVERAGES CERTIFICATE NUMBER: GL/AU/XS/WC x7/19 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 CONTRACTOR OTHER DOCUMENT VVITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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
AVUL5UWK
INSD
WVD
POLICY NUMBER
POLICY EFF
MM/DD
POLICY EXP
MM/DD/YYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE � OCCUR
PREMISES Ea occurrence
$ 300,000
ME EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
A
DTCO-01_109342-COF-18
07/01/2018
07/01/2019
GEN'LAGGREGATE LIMITAPPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
POLICY ❑X PRO JECT ❑ LOC
F1
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
BODILY INJURY (Per person)
$
X ANYAUTO
B
OWNED SCHEDULED
AUTOS ONLY AUTOS
X HIRED �/ NON -OWNED
AUTOS ONLY /� AUTOS ONLY
DT-810-01-109342-TIL-18
07/01/2018
07/01/2019
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
X
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE
$ 5,000,000
B
EXCESS LIAB
CLAIMS -MADE
CUP-OL710395-18-26
07/01/2018
07/01/2019
AGGREGATE
$ 5,000,000
DED I X RETENTION $ 10,000
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
NIA
4210272
07/01/2018
07/01/2019
X1 STATUTE EERH
_
E,L.EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
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)
RE Exhibit Lighting for Fort Collins Museum of Discovery. The City of Fort Collins, its officers, agents and employees are included as Additional Insured for
General Liability and Auto Liability as required by written contract with respects to liability arising out of work performed by the named insured.
City of Fort Collins Purchasing Dept
PO Box 580
Fort Collins
CO 80522-0000
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
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ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD