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HomeMy WebLinkAbout520431 SCHEIDT & BACHMANN USA INC - INSURANCE CERTIFICATE (4)AFRO CERTIFICATE OF LIABILITY INSURANCE DATE(MM,'DD/YYYY) 01 /06/2017 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 endorsement(s). PRODUCER AOn Risk Services Northeast, Inc. Boston MA Office Boston CONTACT NAME: (A/C No. Ext): (866) 283-7122 FAX No.): 800-363-0105 E-MAIL ADDRESS: one Federal street Boston MA 02110 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Travelers Casualty&Surety Co Of America 31194 Scheidt & Bachmann USA Inc INSURER B: Travelers Property Cas CO of America 25674 1001 Pawtucket Blvd. Lowell MA 01854 USA INSURERC: The Travelers Indemnity Co of CT 25682 INSURER D: XL Insurance America Inc 24554 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570065192273 REVISION NUMBER: 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. Limits shown are as requested TR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS D X COMMERCIAL GENERAL LIABILITY US L11 A 1 EACH OCCURRENCE _ffAMA S1,000,000 CLAIMS -MADE X❑ OCCUR ET ENTED PREMISES Ea occurrence $100,000 X MED EXP (Any one person) $10 , 000 Per Occ Ded $15000 PERSONAL &ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- POLICY ❑ JECT ElLOC EC N ODUCTS-COMP/OP AGG PEmp $2,000,000 OTHER: Benefits Per Claim $1, OOO, 000 B AUTOMOBILE LIABILITY Y 810 9199C532 TIL 17 01/01/2017 01/01/2018 COMBINED SINGLE LIMIT Ea accident $500,000 BODILY INJURY ( Per person) ANY AUTO BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY AUTOS HIRED AUTOS NON -OWNED ONLY AUTOS ONLY IComp/Coll PROPERTY DAMAGE Per accident Deductible $1 , 000 UMBRELLA LIAR EACH OCCURRENCE AGGREGATE EXCESS LIAB HIOCCUR CLAIMS -MADE DED RETENTION C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR / PARTNER / EXECUTIVE YUB8427C67617 01/01/2017 01/01/2018 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $100 , 000 OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) ❑ N I A E.L. DISEASE -EA EMPLOYEE $100, 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DiSEASE-PULICY LIMIT $ 500 , 000 A D&O-Primary 105721510 12/20/2016 12/20/2017 Each LOSS Limit $2,000,000 Claims Made Retention $50,000 SIR applies per policy terns & condi ions DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins is included as additional with respect to the general liability policy. 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 AUTHORIZED REPRESENTATIVE 215 North Mason Street, 2nd Floor Fort Collins CO 80524 USA `m c+> t- rn Lo m 0 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 10603646 LOC #: `4 ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk Services Northeast, inc. NAMEDINSURED Scheidt & Bachmann USA Inc POLICY NUMBER See Certificate Number: 570065192273 CARRIER see Certificate Number: 570065192273 NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, 1 FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. ENSR LTR TYPE OF INSURANCE ADDL INSD SUBR W'VD POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/Y POLICY E\PIRATION DATE (MM/DD/YYY LIMITS GENERAL LIABILITY D US00010045LI17A 01/01/2017 01/01/2018 Emp Benefits Aggregate $1,000,000 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD