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HomeMy WebLinkAbout489486 TUV RHEINLAND OF NORTH AMERICA INC - INSURANCE CERTIFICATE (3)TUVRHEI-03 KPETERS .4COR0 �,,,, CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) F12/30/2016 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 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 Rose & Kiernan, Inc. Lee Farm Corporate Park(A/C. 83 Wooster Heights Danbury, CT 06810 CONTACT NAME: PHONE FAX A/c No E:t : (203) 702-4700 A/c, No): (203) 702-4759 AIL ADDRESS: INSURERS) AFFORDING COVERAGE NAIC # INSURER A:Allianz Global Risks US Insurance Company 35300 INSURED INSURER B: Travelers Property Casualty Company of America 25674 INSURER C : TUV Rheinland North America Holding, Inc. INSURER D : 1300 Massachusetts Ave Ste 103 Boxborough, MA 01719 INSURERE: INSURER F : COVERAGES CERTIFICATE NUMBER: 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. INSR LTR TYPE OF INSURANCE ADDLISUBR INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE Al OCCUR CGL2008253 01/01/2017 01/01/2018 DAMAGE TO PREMISES Eaoc u ence $ 100,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 X POLICY PRO ❑ LOC JECT PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY (CEOaccident SINGLE LIMIT 000 > $ 1,000,000 BODILY INJURY (Per person) $ B X ANY AUTO P8103343P614COF17 01/01/2017 01/01/2018 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,00 A EXCESS LAB CLAIMS -MADE ULA2008255 01/01/2017 01/01/2018 DED I X I RETENTION $ 330,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA PJUB3280P50617 01/01/2017 01/01/2018 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 A Professional Liabili 7, PPL2008256 01/01/2017 01/01/2018 Each Claim/Aggregate 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) General Liability: CG2010 04113: Blanket Additional Insured - Owners, Lessees or Contractors - Scheduled Person or Organization General Liability: CG2011 04/13: Additional Insured — Managers or Lessors of Premises General Liability: CG2037 04/13: Additional Insured - Owners, Lessees or Contractors - Completed Operations General Liability: CG2001 04/13: Primary and Non -Contributory General Liability: CG2404 05/09: Waiver of Transfer of Rights of Recovery Against Others to us General Liability: CG24171001 Contractual Liability - Railroads SEE ATTACHED ACORD 101 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins ty THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 215 N Mason St, 2nd Floor P.O. Box 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80525 ACORD 25 (2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD KPETERS 1 ACC)R"' AGENCY CUSTOMER ID: TUVRHEI-03 LOC #: 0 ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMEDINSURED Rose &Kiernan, Inc. TUV Rheinland North America Holding, Inc. 1300 Massachusetts Ave Ste 103 Boxborough, MA 01719 POLICY NUMBER EE PAGE 1 CARRIER NAIC CODE EE PAGE 1 SEE P 1 EFFECTIVE DATE: SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Description of Operations/Locations/Vehicles: Automobile Liability: CAT353 02/15: Blanket Additional Insured and Waiver of Subrogation Clauses included. Umbrella: AGR-CU 2001 07/11: Blanket Additional Insured and Waiver of Subrogation Clauses included. Umbrella: AGRL-CU 4003 (02-13): Primary and Non -Contributory Workers Compensation: WC000313 (00)-01: Waiver of Our Right to Recover from Others Endorsement Workers Comp - WC9903J9 Kansas Waiver of our Right Workers Comp - WC420304 - Texas Waiver of our Right Workers Comp - WC990376 Calif Waiver of our Right City of Fort Collins as an additional insured with respects to General Liability and Automobile Liability but only as required by written agreement per forms noted. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD