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HomeMy WebLinkAboutTEPA LLC - INSURANCE CERTIFICATE (3)30305 A�Il® L! CERTIFICATE OF LIABILITY INSURANCE DATE/YYYY) 3/1/201!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 JAI No Ext : AIC No E-MAIL ADDREss: Nik.Patel@usi.com 90 South Cascade Ave, Ste 940 INSURER(S) AFFORDING COVERAGE NAIC p Colorado Springs, CO 80903 INSURER A: Old Republic Insurance Company 24147 INSURED INSURER B: Travelers Property Casualty Co of America 25674 Tepa, LLC INSURER C 5045 List Drive INSURER D INSURER E : Colorado Springs, CO 80919 INSURER F COVERAGES CERTIFICATE NUMBER: 12793464 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 ADDL LTR TYPE OF INSURANCE N 'SUBR POLICY NUMBER MMIDD/YYYY MM/DO/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR EACH OCCURRENCE $ 1,000,000 DAMO RENTED PREMMI SES Ea occurrence $ 500,000 MED EXP (Any one person) S 10,000 PERSONAL & ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 GEN'L RO- ElPOLICY X❑ JECT LOC PRODUCTS -COMP/OPAGG $ 2,0D0,000 S OTHER: A AUTOMOBILE LIABILITY MWTB 312139 3!1/2018 3/1/2019 _a "';Iidflnt) SINGLE LIMIT $ 1,000.00D BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY(P.'.. 5,000 Med Pay $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? C (Mandatory in NH) N/A MWC 312141 3I1 /2018 3!1/2019 X STATUTE ORH E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEEI $ 1,000,000 If yes, describe under OF OPERATIONS below 1,000,000DESCRIPTION E.L. DISEASE -POLICY LIMIT $ B Installation 660367M779ATIL18 3/1/2018 3/1/2019 $250,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD101, Additional Remarks Schedule, maybe attached if more space is required) Certificate holder is recognized as an additional insured as respects: Contractors License fax:970-224-6134 1_ANUt:LLA I IL11N City Of Ft. Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O. BOX 580 ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins CO 805220580 AUTHORIZED REPRESENTATIVE 9( 00, The ACORD name and logo are registered marks of ACORD © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 11111111 III 1111111 III 11111111111111111111111111111111111 111111111111111111111111 III 'CYB 01 AO 7 /002788/02/02/0/0/0/0'