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HomeMy WebLinkAbout102630 AYRES ASSOCIATES INC - INSURANCE CERTIFICATE (14)DATE (MM/DDIYYYY) A�CORD0 CERTIFICATE OF LIABILITY INSURANCE 12119/2016 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 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 CONTACT NAME: Sharon Bannach Arthur J. Gallagher Risk Management Services, Inc. PHONE 262-792-2214 _ FAX(ALC 262-792-1712 17035 W Wisconsin Ave., Suite 135 (A/C,Bo.a,)_ —_ E-MAIL Sharon _Bannach@a com Brookfield WI 53005 ADORE _ Jg _ INSURERS) AFFORDING COVERAGE NAIC 8 INSURER A:Travelers Property Casualty Co of A 25674 INSURED AYREASS-02 INSURER B:Travelers Indemnity Co of America 25666 AYRES ASSOCIATES INC INSURERc:The Travelers Indemnity Company of 25682 3433 Oakwood Hills Parkway Eau Claire, WI 54702-1509 INsuRERD: f1r%11rDAf_rC f`COTICIPATC 1UIIPARrD• 15715991n3 D97111(ZinN NIIRARFI?- 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 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD JB1RT_ TYPE OF INSURANCE DL� POLICY EFF POLICY EXP LIMITS LTR I WVD POLICY NUMBER MMIDDNYYY MMID B X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X❑ OCCUR Y P6302183P260TIA17 1/1/2017 1/1/2018 EACH OCCURRENCE $1,000,000 PREMISES Ea occENcu rr $100,000 MED EXP (An one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY � PRO- LOC OTHER: GENERAL AGGREGATE $2,000,000 X PRODUCTS - COMPIOP AGG $2,000,000 $ A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED X AUTOS ONLY X AUTOS ONLY Y P8103790P125TILl7 1/1/2017 1/1/2018 Ea accident $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ _ 0PERT7`DAMAGF— Per accident) $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE PSMCUP3790P149TIL17 1/1/2017 1/1/2018 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 DIED X RETENTION $0 $ A C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE — OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A PJUB2528P88117 PDTSEUB2522P94417 1/1/2017 1/1/2017 1/1/2018 1/1/2018 X STATUTE EORH E.L. EACH ACCIDENT $500,000 — E.L. DISEASE - EA EMPLOYEE -- --- $500,000 E.L. DISEASE - POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins is included as Additional Insured for General Liability policy providing ongoing and completed operations coverage as per blanket endorsement CGD4 14 04-08 and Auto Liability as per form CAT3 53 0310. CERTIFICATE HOLDER CANCELLATION City of Fort Collins Public Works - Utilities, Stormwater 700 Wood Street Fort Collins CO 80521 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 REPRESENT TIVE s_hb� r� © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD