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HomeMy WebLinkAbout520431 SCHEIDT & BACHMANN USA INC - INSURANCE CERTIFICATE (5)---� CERTIFICATE OF LIABILITY INSURANCE ACORO DATE(MM/DD/YYYY) ovoa/zola 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 CONTACT NAME: PHONE JNExt): o. (866) 283-7122 (aC No ); 800-363-0105 E-MAIL ADDRESS: one Federal Street Boston MA 02110 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURERA: Travelers Casualty&Surety Co Of America 31194 Scheidt & Bachmann USA Inc INSURER B: The Travelers Indemnity Co. 25658 1001 Pawtucket Blvd Lowell MA 01854 USA INSURER C: Travelers Property Cas Co of America 25674 INSURER D: XL Insurance America Inc 24554 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570069848248 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 INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD LIMITS D X COMMERCIAL GENERAL LIABILITY USQUOiU041-I16A EACH OCCURRENCE S1,000,000 CLAIMS -MADE X❑ OCCUR DAMAGE TRENTED PREMISES Ea occurrence $100,000 X MED EXP (Any one person) $10 , 000 Per Occ Ded $15,000 PERSONAL &ADV INJURY $1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY ❑ PRO ❑ JECT LOC PRODUCTS - COMP/OP AGG $2,000,000 OTHER: Emp Benefits Per Claim $1, 000 , 000 C AUTOMOBILE LIABILITY 810-9199C532 01/01/2018 01/01/2019 COMBINED SINGLE LIMIT Ea accident $S00,000 BODILY INJURY ( Per person) X ANYAUTO BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY AUTOS PROPERTY DAMAGE HIRED AUTOS NON -OWNED E Per accident ONLY AUTOS ONLY ComplColl Deductible $1, 000 I — UMBRELLA LIAR EACH OCCURRENCE AGGREGATE EXCESS LIAB HOCCUR CLAIMS -MADE DED RETENTION B WORKERS COMPENSATION AND uB93391799 01/01/2018 01/01/2019 X I STATUTE OTH ER EMPLOYERS' LIABILITY Y/N E.L. EACH ACCIDENT $100,000 C ANYPROPRIETOR/ PARTNER I EXECUTIVE NIA B9 U693235300 Ol/O1/2018 Ol/Ol/2019 OFFICER/MEMBEREXCLUDED? (Mandatory in NH) CA E.L. DISEASE -EA EMPLOYEE $100,000 If yes, describe under DESCRIPTION OF OPERATIONS balow E.L. DISEASE -POLICY LIMIT $ 500 , 000 A D&O-Primary lOS721510 12/20/2017 12/20/2018 Each Loss Limit $2,000,000 Claims Made Retention $50,000 SIR applies per policy terins & 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 m cc V tv cc 0) to 0 O Z O R V L tv U S-� J1 f� SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE �1 EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE y POLICY PROVISIONS. City of Fort Collins AUTHORIZED REPRESENTATIVE 215 North Mason street, 2nd Floor Fort Collins Co 8OS24 USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD CANCELLATION AGENCY CUSTOMER ID: 10603646 LOC #: A ADDITIONAL REMARKS SCHEDULE Page _ of AGENCY Aon Risk Services Northeast, Inc. NAMED INSURED Scheidt & Bachmann USA Inc POLICY NUMBER see Certificate Number: 570069848248 CARRIER See Certificate Number: 570069848248 NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACOFZD 25 FORM TITLE: Certificate of Liabilitv 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. [NSR LTR TYPE OF INSURAN ADDL [NSD SUBR WVD POLICI''NUMBER POLICY EFFECTIVE DATE MM/DD/Y POLICY EXPIRATION DATECE ATE (MM/DD/YYYY) LIMITS GENERAL LIABILITY D us00010045L118A 01/01/2018 01/01/2019 Emp Benefits Aggregate $1,000,000 ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD