HomeMy WebLinkAboutTEPA LLC - INSURANCE CERTIFICATE (5)30305
DATE (MMIDDIYYYY)
kk. R_ CERTIFICATE OF LIABILITY INSURANCE
�,�- 2/28f2017
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: Arnie Schans
Commercial Lines - (800)-332-9256 PHONE 303-863-4651 F IC 855-669-8729
A/C, Nq, A/C No
Wells Fargo Insurance Services USA, Inc. ADDRESS: Arnold.Schans@wellsfargo.com
90 S. Cascade Ave, 2nd Floor INSURERS AFFORDING COVERAGE NAIC 0
Colorado Springs, CO 80903 INSURER A: Old Republic Insurance Company 24147
INSURED INSURER B ; Travelers Property Casualty Cc of America 25674
Tepa, LLC
INSURER C :
5045 List Drive
INSURER D
INSURER E :
Colorado Springs, CO 80919 INSURER F :
COVERAGES CERTIFICATE NUMBER: 11512747 REVISION NUMBER: See below
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 SUBR POLICY NUMBER MM LTR IDD/YYYY MMIDDIYYYY LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE 1XI OCCUR
MWZY 309532
3/1/2017
3/1/2018
EACH OCCURRENCE
$ 1,000,000
PREMISES Ea occurrence)
$ 500,000
MED EXP (Any one person)
S 10,000
PERSONAL 8 ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2.000,0150
PRO -
POLICY � ECT LOC
F1
PRODUCTS - COMP/OP AGG
$ 2,000,000
S
OTHER:
•
AUTOMOBILE
LIABILITY
MWTB309531
3/1
3/1/2018
CccidDSINGLELIMIT
(Ea aaccid/2017
$ent 1,000,000
X
_
BODILY INJURY (Per person)
$
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
S
x
PROPERTY DAMAGE
Per accident
$
HIRED X NON -OWNED
AUTOS ONLY AUTOS ONLY
5,000 Med Pay
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAR
CLAIMS -MADE
DED RETENTION$
$
A
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY YIN
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? N.
(Mandatory in NH)
NIA
MWC309530
3/1/2017
3/1/2018
X STATUTE EORH
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
$ t,000,000
B
Installation
660367M779ATIL17
3/1/2017
3/1/2018
$250,000
Leased/Rented Equipment
$500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Certificate issued as proof of coverage. FAX: 970.224.6134
GER FIFIGAf E HVLDEK UANUI_LLA I IVN
Fort Collins Contractor SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
PO Box 580 ACCORDANCE WITH THE POLICY PROVISIONS.
Fort Collins CO 805220580
AUTHORIZED REPRESENTATIVE
ge-4a,
The ACORD name and logo are registered marks of ACORD @ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) 1 IIIIIII III IIIIIII IIII 11111111111 IIII 111111111111111111111111111111111111111111111 IIII IIII