HomeMy WebLinkAboutWALKER MANUFACTURING CO - INSURANCE CERTIFICATE (10)ACORO CERTIFICATE OF LIABILITY INSURANCE
DATE(MWDD/YYYY)
3/20/2017
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
Flood and Peterson
PO Box 578 RECEIVED
Greeley CO 80632 A� ioi °
CONTACT Kelly Beauvais, CIC, CISR
PHONE (970) 356-0123 FAX (970)330-1867
A/C No):
;-DDR1ESS:kbeauvais@floodpeterson.com
INSURERS AFFORDING COVERAGE
NAIC p
INSURERA:Twin City Fire Insurance Company
29459
INSURED ,� ,
Walker Manufacturing Co. cay Managers Offi
5925 East Harmony Road
Fort Collins CO 80528
SURERB:Sentinel Insurance Company
11000
INsuRER c :Pinnacol Assurance
41190
INSURERD:
INSURER E : _
INSURERF:
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
ADDL
SUBR
-
POLICY NUMBER
POLICY EFF
MWDD/YYYY
POLICY EXP
MM DD/YYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES Ea occurrence
$ 3 0 0, 0 0 0
A
�� �
CLAIMS -MADE OCCUR
MED EXP (Any one person)
34ECSOF1729
9/30/2016
9/30/2017
$
PERSONAL & ADV INJURY
$ 1,000,000
GEN'L
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
X
❑PRO -
POLICY
JECT LOC
PRODUCTS - COMP/OPAGG
$ 2,000,000
BLWOS
$
OTHER:
AUTOMOBILE
LIABILITY
Oa accident) SINGLE LIMIT
E
$ 1,000,000
X
BODILY INJURY (Per person)
$
B
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
34UUNNJ0856
9/30/2016
9/30/2017
BODILY INJURY (Per accident)
$
HIRED AUTOS X NON -OWNED
AUTOS
X
PROPERTY DAMAGE
Per accident
$
Uninsured motorist combined
$ 1,000,000
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DE D RETENTION
$
WORKERS COMPENSATION
_
X
AND EMPLOYERS' LIABILITY Y f N
STATUTE ERH
E.L. EACH ACCIDENT
$ 500, 000
ANY PROP RIETOR/PARTNER/ED?XECUTIVE
OFFICER/MEMBER EXCLUDE ❑
N/A
E.L. DISEASE - EA EMPLOYEE
$ 500,000
C
(Mandatory in NH)
If yes, describe under
2270632
4/1/ 2017
4/1/2018
E.L. DISEASE - POLICY LIMIT
$ 500,000
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Certificate Holder is Additional Insured as their interests may appear regarding land leased at:
City Manager; City of Ft. Collins
300 LaPorte Ave
Fort Collins, CO 80521
I.HIVI.CLLA I IVIV
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
Beauvais, CIC, CISR ,V"-V "
U 1985-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
INS025 (201401)