Loading...
HomeMy WebLinkAboutTEPA LLC - INSURANCE CERTIFICATE (2)30305 ACORD® �, CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 3/1/2018 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 Commercial Lines - (800)-332-9256 US[ Insurance Services National, Inc. CONTACT NAME: Nik Patel PHONE 303-863-6318 FAx 855-669-8729 /C No Ext : AlC' No): (A/C. E-MAIIE-ADDRss: Nik.Patel@usi.com 90 South Cascade Ave, Ste 940 INSURERS AFFORDING COVERAGE NAIC # Colorado Springs, CO 80903 INSURERA: Old Republic Insurance Company 24147 INSURED Tepa, LLC INSURER B: Travelers Property Casualty Co of America 25674 INSURERC: 5045 List Drive INSURER D: INSURER E : Colorado Springs, CO 80919 INSURER F : COVERAGES CERTIFICATE NUMBER: 12793445 REVISION NUMBER: See below 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 TYPE OF INSURANCE ADDL wV POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LIMITS LTR IN SUBR _ - POLICY EFF . POLICY E%P A )( COMMERCIAL GENERAL LIABILITY CLAIMS -MADE u OCCUR MWZY312140 3/1/2018 3/1/2019 EACH OCCURRENCE $ 1,000,000 S (Ea occurrence RENTED PREMIREMI DAMAGEREMISES $ 500,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000.000 POLICY ECT LOC PRODUCTS -COMP/OP AGG $ 2,000,000 $ OTHER A AUTOMOBILE LIABILITY MWTB 312139 I 3/1/2018 3/1/2019 E� eBcdDeISINGLELIMIT $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO IXX OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED x NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ 5,000 Mad Pay $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ I A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N OFFCERAI MBEREXCLUDED?ECUTIVE N (Mandatory in NH) NfA MWC 312141 3/1/2018 3/1/2019 X STATUTE EPER ORH E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 Wes. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ t.000.000 B Installation 660367M779ATIL18 3/112018 3/1/2019 $25o,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate issued as proof of coverage. FAX: 970.224.6134 CERTIFICATE HOLDER CANCELLATION Fort Collins Contractor SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO Box 580 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins CO 805220580 AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) I IIIIIII III IIIIIII IIII IIIII IIIIII IIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII 'CYB01A011002169/02/020.M'