HomeMy WebLinkAboutEL DORADO NATIONAL (CALIFORNIA) INC - INSURANCE CERTIFICATE (3)ACORE° CERTIFICATE OF LIABILITY INSURANCE
�4—� 7/1/2019
DATE(MM/DD/YYYY)
6/28/2018
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 Lockton Companies
Three City Place Drive, Suite 900
St. Louis MO 63141-7081
(314) 432-0500
CONTACT
NAME:
NE
A/c, No, Ext : A/C, No):
E-MAIL
ADDRESS:
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A: Great American E & S Insurance Company
37532
INSURED El Dorado National (California), Inc.
1373851 9670 Galena Street
Riverside CA 92509
INSURER B: Travelers Property Casualtv Co of America
25674
INSURER C : AXIS Surplus Insurance Com anN,
26620
INSURER o : The Charter Oak Fire Insurance Com an
2561 5
INSURER E :
INSURER F
COVERAGES ALLSP CERTIFICATE NUMBER: 14499744 REVISION NUMBER: XXXXXXX
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
INSD
SUBR
WVD
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MM/DD/YYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE 7 OCCUR
Y
N
PL1744639-01
7/l/2018
7/1/2019
EACH OCCURRENCE
1,000,000
PREMISES ((ETO a RENTED
)
$ 300,000
MED EXP (Any one person)
XXXXXXX
PERSONAL & ADV INJURY
$ 1 .000,000
GEN'L AGGREGATE LIMIT APPLIES PER.
}{ POLICY JE � LOC
OTHER:
GENERAL AGGREGATE
$ 4,000,000
PRODUCTS - COMP/OP AGG
$ 4,00U00
$
B
AUTOMOBILE
LIABILITY
ANY AUTO
AAUTOS ONLY SCHEDULED
AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
Y
N
TC2JCAP8E082581T1L18
7/1/2018
7/1/2019
CEOMBIINaccidEeDtSINGLELIMIT
$ 1,000 000
X
BODILY INJURY (Per person)
$ XXXXXXX
BODILY INJURY (Per accident
$ XXXXXXX
PROPERTY DAMAGE
(Per accident
$ XXXXXXX
$XXXXXXX
C
UMBRELLA LIAR
EXCESS LIAB
I -
OCCUR
CLAIMS -MADE
N
N
EAU781897012018
7/1/2018
7/1/2019
EACH OCCURRENCE
$ 5,000 000
X
AGGREGATE
$ 5,000 000
DED I I RETENTION $
$ XXXXXXX
D
WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N
OFFICER/MEMANYPROPRIETOER EXCLUDED? ECUTIVE �
(Mandatory in NH(
If yes, escribe under
DESCRIPTION OF OPERATIONS below
N / A
N
TC20UB118D488218
7/1/2018
7/1/2019
X STATUTE OER
E.L. EACH ACCIDENT
$ I MONO
E.L. DISEASE - EA EMPLOYEE
$ 1,000.000
E.L. DISEASE -POLICY LIMIT
1,000,000
B
Garage Keepers Liability
N
N
TC2JCAP8E082581T1L18
7/1/2018
7/1/2019
Blanket $5,000,000 by location
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CITY OF FORT COLLINS IS ADDITIONAL INSURED UNDER THE GENERAL LIABILITY AND AUTOMOBILE LIABILITY AS REQUIRED BY
WRITTEN CONTRACT. THE INSURNACE EVIDENCED BY THIS CERTIFICATE WILL NOT REDUCE COVERAGE OR LIMITS AND WILL NOT BE
CANCELLED, EXCEPT AFTER THIRTY (30) DAYS WRITTEN NOTICE HAS BEEN RECIEVED BY THE CITY OF FORT COLLINS.
CERTIFICATE HOLDER CANCELLATION See Attachment
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
14499744 AUTHORIZED REPRESENTATIVE
CITY OF FORT COLLINS
215 NORTH MASON STREET
FORT COLLINS CO 80524
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