HomeMy WebLinkAboutAMI FIREPLACE COMPANY INC - INSURANCE CERTIFICATE (4)A�oRo® CERTIFICATE OF LIABILITY INSURANCE 73/28/2018
E(MM/DDYVYV)
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
NAME:
Cottingham & Butler PHONE FAX
Bradley J. Plummer AAA Lo ,d • 563-587-5000 A/c No): 563-583-7339
800 Main St. ADDRESS:
Dubuque IA 52001 INSURERS AFFORDING COVERAGE NAIC#
INSURERA: Hartford Fire Insurance Company 19682
INSURED BAYINDI INSURERB: National Fire & Marine Insurance Company 20079
AMI Fireplace Company Inc. INSURERC: Twin City Fire Insurance Co. 29459
PO Box 9229
Green Bay WI 54308 INSURERD:
INSURER E :
rr1VFRAr_FS rFRTIFICATF NIIMRFR• 17900A911F RFVISION NIIMRFR-
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
OF INSURANCE
ADDLSUBRTYPE
INSD
WVD
POLICY NUMBER
MM DDPUCY/YYYY
DD/YYYY
MML
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
�X I
CLAIMS -MADE � OCCUR
Y
Y
83UENOB8025
4/1/2018
4/1/2019
EACH OCCURRENCE
$1,000,000
_7
DAMAGE TO RENTEU-
PREMISES Ea occurrence
$ 300,000
MED EXP (Any one person)
$ 10,D00
PERSONAL & ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO [X]LOC
EJECT OTHER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
A
AUTOMOBILE LIABILITY
X ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
X HIRED X NON -OWNED
AUTOS ONLY AUTOS ONLY
V
Y
83UENOB8026
4/1/2018
4/1/2019
COMBINED SINGLE LIMIT
Ea accident
$1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
$
B
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
Y
Y
42-UMO-301172-04
4/1/2018
4/1/2019
EACH OCCURRENCE
$ 25,000,000
AGGREGATE
$ 25,000,000
DED X RETENTION $
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑
(Mandatory in NH)
DEunder
yes, describe Or DSCRIPTION OPERATIONS bc!ow
N/A
Y
83WE088052
4/1/2018
4/1/2019
X STATUTE EERH
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE - EA EMPLOYEE
$1,000,000
EL. DISEASE -POLICY LIMIT
$ 1,000.000
A
Property
83UUNAJ7334
4/1/2018
4/1/2019
Blanket Building/BPP
Deductible
126,184,404
25,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Fort Collins
P.O. Box 580 AUTHORIZED REPRESENTATIVE
Fort Collins CO 80522
U 1968-ZU15 AGVKU UL)KF'uKA I ION. All rignLS reservea.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD