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HomeMy WebLinkAboutJ & R ELECTRIC INC - INSURANCE CERTIFICATE (3)ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 11/14%2017 I 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 FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 CONTACT NAME: CLIENT CONTACT CENTER A/OCNNo,Ext : 888-333-4949 FAX No): 507-446-4664 E-MAIL ADDRESS: CLIENTCONTACTCENTER(dFEDINS.COM OWATONNA, MN 55060 INSURERIS) AFFORDING COVERAGE NAIC # INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 374-201-2 INSURER B: J & R ELECTRIC INC INSURER C: 4251 S NATCHES CT STE E ENGLEWOOD, CO 80110-8603 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 4 REVISION NUMBER: 0 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 DDL INSR SUBR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MM/DDIYYYV LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR Y Y 9085825 12/30/2017 12/30/2018 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence) $100,000 MED EXP (Any one person) EXCLUDED GEN'L X PERSONAL & ADV INJURY $1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY ❑PRO ❑ LOC JECT OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMPIOP AGG $2,000,000 A AUTOMOBILE X LIABILITY ANY AUTO OWNED AUTOS ONLY SCHEDULED AUTOS HIRED AUTOS ONLY NON -OWNED AUTOS ONLY N N 9085825 12l30/2017 12/30/2018 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE per acciden A X UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE N N 9085826 12/30/2017 12/30/2018 EACH OCCURRENCE $3,000,000 AGGREGATE $3,000,000 DED I I RETENTION A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNERIEXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA Y 9085827 12/30/2017 12/30/2018 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 E.L DISEASE -POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) SEE ATTACHED PAGE CFRTIFICATF 1401 DFR CANCELLATION 374-201-2 40 CITY OF FORT COLLINS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO BOX 580 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN FORT COLLINS, CO 80522-0580 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 374-201-2 LOC ##: ACO ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMEDINSURED FEDERATED MUTUAL INSURANCE COMPANY J & R ELECTRIC INC 4251 S NATCHES CT STE E ENGLEWOOD, CO 80110-8603 POLICY NUMBER SEE CERTIFICATE ## 4.0 CARRIER CODE 77`C SEE CERTIFICATE ## 4.0 EFFECTIVE DATE: SEE CERTIFICATE ## 4.0 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSORS OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL LIABILITY. GENERAL LIABILITY CONTAINS A WAIVER OF SUBROGATION IN FAVOR OF THE CERTIFICATE HOLDER SUBJECT TO THE CONDITIONS OF THE BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY ENDORSEMENT. WORKERS COMPENSATION CONTAINS A WAIVER OF SUBROGATION IN FAVOR OF THE CERTIFICATE HOLDER. ACORD 101 (2008/01) O 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD