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HomeMy WebLinkAboutPOLE MOUNTAIN ELECTRIC INC - INSURANCE CERTIFICATE (3)POLEMOU-02 CHMCRADY CERTIFICATE OF LIABILITY INSURANCE D TE 06/157 06/15/I2 Y017 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 Wyoming Financial Insurance 6101 Yellowstone Rd, Ste 100 Cheyenne, WY 82009 CONTACT Chris MCRady PHONE FAX (A/C, No, Ext): (307) 432-4153 (A/C, No): E-MAIL . cmcrady@weres.com INSURERS AFFORDING COVERAGE NAIC # INSURER A:EMC Insurance Group Inc INSURED INSURER B : INSURER C : Pole Mountain Electric, Inc. PO Box 926 Cheyenne, WY 82003 INSURER D : INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER- vGVICInNI IUI RAQCo. 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 T rypE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM! D POLICY EXP MM DDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR X4X5566918 06/16/2017 06/1612018 EACH OCCURRENCE $ 1,000,000 PDARMIAGE TO RENTED occurrence) $ 100,000 MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ECT El LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 X BODILY INJURY Perperson) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS 4X5566918 06/16/2017 06/16/2018 BODILY INJURY Per accident PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY A X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 AGGREGATE 2,000,000 EXCESS LIAR CLAIMS -MADE 4X5566918 06/16/2017 06/16/2018 DED I X I RETENTION $ 10,000 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N4X5566918 ANY PROPRIETOR/PARTNER/EXECUTIVE FFICER/MEMBER EXCLUDED ❑ Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WY STOP GAP 06/16/2017 06/16/2018 PER X OTH- TER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT 1,000,000 $ A Equipment Floater 4X5566918 06/16/2017 06/16/2018 Leased/Rented 50,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Automatic Additional Insured on the GL per form CG7174.3 if required by written contract. (Form available upon request) City of Fort Collins P.O. Box 580 Fort Collins, CO 80522 LOLIAO Ly a A A_1 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 64�- x*ft A(:UKU LS (LU1b/UJ) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD