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HomeMy WebLinkAbout489486 TUV RHEINLAND OF NORTH AMERICA INC - INSURANCE CERTIFICATE (5)i _604I TUVRHEI-03 SSWENSON ,ft v CERTIFICATE OF LIABILITY INSURANCE D 01/05/2 Y8 `--� 1 /05/018 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 CONTACT NAME: Rose & Kiernan, Inc. PHONE FAX Lee Farm Corporate Park (A/C, No, Et): (203) 7024700 (A/C, No):(203) 7024759 83 Wooster Heights ADDRE Danbury, CT 06810 INSURED TUV Rheinland of North America, Inc. 295 Foster Street, Suite #100 Littleton, MA 01460 Allianz Global Risks US Insurance Companv 35300 The Charter Oak Fire Insurance Company 25615 Travelers Property Casualty Company of America 25674 CnVFRAGFR CFRTIFICATF NI IMRFR• RFVISIr1NI FJI IMRFR- 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 TYPE OF INSURANCE ADDL SUBINSID WV DPOLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F7X OCCUR CGL2011074 01/01/2018 01/01/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED P MI E Ea urrence 100,000 $ MED EXP (Any oneperson) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY JECT LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 $ BODILY INJURY Perperson) $ X ANY AUTO OWNED SCHEDULED P8103343P614COF18 01/01/2018 01/01/2019 AUTOS ONLY AUTOS BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE ULA 2011075 01/01/2018 01/01/2019 DED X I RETENTION $ 330,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ WFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A PJUB3280P50618 01/01/2018 01/01/2019 X ISTAT ORH- E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 $ A Professional Liabili PL 2011284 01/01/2018 01/01/2019 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: AGRL-CG6001 04/10 — Additional Insured — When required by written contract General Liability: CG2010 04113: Blanket Additional Insured - Owners, Lessees or Contractors - Scheduled Person or Organization General Liability: CG2011 04113: Additional Insured — Managers or Lessors of Premises General Liability: CG2037 04113: Additional Insured - Owners, Lessees or Contractors - Completed Operations General Liability: AGR-IL M002 11/03 - Amendment to Condition- Other Insurance - Primary and Non -Contributory General Liability: CG2404 05/09: Waiver of Transfer of Rights of Recovery Against Others to us General Liability: CG2417 10101 Contractual Liability - Railroads SEE ATTACHED ACORD 101 City of Fort Collins 215 N Mason St, 2nd Floor P.O. Box 580 Fort Collins, CO 80525 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 REPRESENTATIVE C� �./t7�- ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SSWENSON / 1 AC"WX AGENCY CUSTOMER ID: TUVRHEI-03 LOC #: 0 ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED Rose &Kiernan, Inc. TUV Rheinland of North America, Inc. 295 Foster Street, Suite #100 POLICY NUMBER Littleton, MA 01460 EE PAGE 1 CARRIER NAIC CODE EE PAGE 1 ISEE P 1 EFFECTIVE DATE: SEE PAGE 1 WDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Description of Operations/LocationsNehicles: Automobile Liability: CAT353 02/15: Blanket Additional Insured and Waiver of Subrogation Clauses included. Umbrella: AGR-CU 2001 07111: Blanket Additional Insured and Waiver of Subrogation Clauses included. Umbrella: AGRL-CU 4003 (02-13): Amendment — Other Insurance Condition - 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 Page 1 of 1 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