HomeMy WebLinkAbout102630 AYRES ASSOCIATES INC - INSURANCE CERTIFICATE (13)AC� ® DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE F,2/19/2017
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 endorsements .
PRODUCER CONTACT
NAME: Sharon Bannach
Arthur J. Gallagher Risk Management Services, Inc. PHONE 262 792 2214 FAXC. Nol,262 792 1712
245 South Executive Drive, Suite 200 E-MAIL
Brookfield WI 53005 . Sharon_Bannach@ajg.com
INSURED
AYRES ASSOCIATES INC
3433 Oakwood Hills Parkway
Eau Claire, WI 54702-1509
AYREASS-02
INSURER A: Travelers Property Casualty Co of America 125674
INSURER B:The Travelers Indemnity Company of CT 125682
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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 DLTSUBR POLICY EFF -POLICY EXP _
LTR ' TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE XI OCCUR
Y
P6302183P260TIA18
111/2018
1/1/2019
EACH OCCURRENCE
$1,000,000
AMAGE TO RENTED
PREMISES Ea occurrence
$100,000
MED EXP (Any one person)
$10,000
PERSONAL & ADV INJURY
$1,000,000
GEN'L
AGGREGATE LIMIT APPLIES PER:
PO-
POLICY 7 JECT E LOC
OTHER:
GENERAL AGGREGATE
$2,000,000
X
PRODUCTS - COMP/OP AGG
$2,000,000
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY X AUTOS ONLY
Y
P8103790P125TIL18
1/1/2018
1/1/2019
COMBINED b=E LIMIT
Ea accident
$ 1,000,000
X
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
X
PROPERTY DAMAGE
Per accident)
$
$
A
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS MADE
PSMCUP3790P149TIL18
1/1/2018
1/1/2019
EACH OCCURRENCE
$5,000,000
AGGREGATE
$5,000,000
DIED I X I RETENTION $0
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y /N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑N
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
UB911943775018
1/1/2018
1/1/2019
X P OTH-
STATUTE ER
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE - EA EMPLOYEE
$1,000,000
E.L. DISEASE - POLICY LIMIT
$1,000,000
7
1 i
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
The City of Fort Collins is included as Additional Insured for General Liability per form CGDO 37 0405 and Auto Liability per form CAT3 53 031
CERTIFICATE HOLDER CANCELLATION
The City of Fort Collins
Purchasing Department
PO Box 580
Fort Collins CO 80522
USA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTT1VE
VVIP
I0 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD