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HomeMy WebLinkAboutSIMPSON ELECTRIC INC - INSURANCE CERTIFICATE (17)i� SIMPELE-01 RFISHER AC-ORD CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY) �-.--� z/24/2za/zo17 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 NAAME: CT Rhonda Fisher TrueNorth PHONE FAX Phone: (303) 776-5122 (303 ) 774-2853 INC, Not: (303) 776-5495 275 S. Main Street A ASS: rfisherQtruenorthcompanies.com Lonamont. CO 80502 INSURED Simpson Electric, Inc dba Simpson Electric of Colorado PO Box 2196 Loveland, CO 80539 INSURERS) AFFORDING COVERAGE NAIL N INSURERA:Owners Insurance Company 32700 INSURER B: Auto Owners Insurance Company 18988 INSURER C: Pinnacol Assurance Company 41190 INSURERD:Zurich American Insurance Company 1653_5_ INSURER E : INSURER F : COVFRAGES 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 TYPE OF INSURANCE ADOL'SUBW POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MMID MMIDD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 1 CLAIMS -MADE X OCCUR X 74143794 02/20/2017 04/01/2017 PREMISES Ea occurrence $ 300,00 $ 5,00 MED EXP (Any one person) $ 1,000,00 PERSONAL 8 ADV INJURY $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE X POLICY JE� LOC a OTHER: PRODUCTS-COMP/OPAGO $ 2,000,000 $ AUTOMOBILE LIABILITY X ANY AUTO 4268565900 EO�MBBIINdEDj SINGLE LIMIT entA 1 11/24/2016 11/24/20171 BODILY INJURY (Per person) $ 1,000,000 $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIREDAUTOS NON -OWNED AUTOS PROPERTY DAMAGE (PeraWowl) __--- $ $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS Ll48 CLAIMS -MADE 4268665901 02120=17 04/01/2017 AGGREGATE $ 1,000,00 -$ DED X RETENTION$ 5,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY C IANYPROPRIEfOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA 182129 04/01/2016 OM01/2017 X OTH- STATUTE ER _ E.L.EACHACCIDENT Is 1,000,00 E.L.DISEASE - EA EMPLOYE $ 1,000,00 If yes, describe under DESGRiPTiGIV OF OPERATIONS below E.L. DISEASE - POLCY LIM!T 5 1,000;000 D Workers Compensation C007998801 04/01/2016 04/01/2017 See Descr of Ops DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) WORKERS COMPENSATION - OTHER STATES COVERAGEINEBRASKA: Employers Liability: Each Accident: $1,000,000; Policy Limit: $1,000,000; Each Employee: $1,000,000 City of Fort Collins is included as Additional Insured with regards to General Liability, where required by written contract or agreement, per policy forms and endorsements. L,tK I It-IUA I t MULUtK t.AIVL.tLLA I IUN City of Fort Collins Attn: Laurie P.O. Box 580 Fort Collins, CO 80522 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 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD