HomeMy WebLinkAbout457775 FARNSWORTH GROUP INC - INSURANCE CERTIFICATE (5)P52610281102
ACOKU� CERTIFICATE OF LIABILITY INSURANCE
DATE(MMlDDIYYYY)
06/04/2018
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 1-800-527-9049
CONTACT NAME: Linda Bcmarito / Audrey McNeill
Holmes Murphy and Associates
- Peoria
311 S.W. water Street
PHONE 309-683-1065 FAX 888-898-6604
AIC No
E-MAIL
ADDRESS: AMcNeillQholmeamurphy.com
INSURERS AFFORDING COVERAGE
NAIC 0
Suite 211
_
INSURERA:XL SPECIALTY INS CO
37885
Peoria, IL 61602-4108
INSURED
INSURER B :
Farnsworth Group, Inc.
INSURER C
INSURER D:
2709 McGraw Drive
INSURER E :
INSURER F:
Bloomington, IL 61704
COVERAGES CERTIFICATE NUMBER: 52983674 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE POLICY NUMBER MMIDDNYYY MWDD
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$
CLAIMS -MADE OCCUR
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$
MED EXP (Any one person)
$
PERSONAL 8 ADV INJURY
f
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$
GEN'L
POLICY D PECOT LOC
PRODUCTS - COMP/OP AGG
f
i
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY (Per person)
$
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
BODILY INJURY (Per accident)
$
PROPERTYDAMAGE
Per accident
s
S
UMBRELLA LIAB
��OCCUR
EACH OCCURRENCE
f
AGGREGATE
$
EXCESS LUIB
_CLMS-MADE
DED RETENTION b
i
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETOR/PARTNEREXECUTIVE F
OFFICER/MEMBERE%CLUDED7
(Mandatory In NH)
NIA
ER
PTATUTE OTH
ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
f
E.L. DISEASE - POLICY LIMIT
$
If yes, descnbe under
DESCRIP (ION OF OPERATIONS below
I
I
I
I
A
Professional Liability
DPR9925613
06/15/18
06/15/19
Each Claim
5.000,000
(Claims Made)
Aggregate
10,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
The professional liability policy contains a 30 day notice of cancellation as required by written contract with the
insured, per policy terms and conditions.
Farnsworth Group, Inc. Project Manger: Eric Culver
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
ty of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
P.O. BOX 580 AUTHORIZED REPRESENTATIVE
215 N. Mason
Fort Collins, CO 80524
USA
01988-2915 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103)
lbomaritoil
52983674
The ACORD name and logo are registered marks of ACORD