HomeMy WebLinkAbout263373 ELECTRONIC SYSTEMS INTERNATIONAL - INSURANCE CERTIFICATE (2)ELECSYS-01
SSTORM
CERTIFICATE OF LIABILITY INSURANCE
FDAl-(MM/DD/YYYY)
12128/2017
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 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 Suzanne Storm
HO,N o, Ext : (719) 867-4502 Nc, No :(719) 590-9992
Six & Geving Insurance, Inc.
3630 Sinton Rd.
Suite 200
E-MAIL , sstorm@six-geving.com
Colorado Springs, CO 80907
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A: Colony Insurance Company
INSURED
INSURER B : Acuity
14184
INSURER C : Pinnacol Assurance
41190
Electronic Systems International, Inc.
INSURER D :
3010 Mallard Drive
Colorado Springs, CO 80910-2247
INSURER E
INSURER F :
CnVERAGFS CERTIFICATE NUMBER: REVISION NUMBER: 2
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
MM DD
POLICY EXP
MM DD
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE ❑X OCCUR
X
103GL0001664-04
01/01/2018
01/01/2019
EACH OCCURRENCE
2,000,000
DAMAGE TSESO R(EaENTEDREM occurrence)
$ 100,000
MED EXP (Any oneperson)
5,000
PERSONAL & ADV INJURY
2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO ❑ LOC
JECT
OTHER:
GENERAL AGGREGATE
3,000,000
PRODUCTS - COMP/OP AGG
3,000,000
B
AUTOMOBILE LIABILITY
X ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
X
L75688
01/01/2018
01/01/2019
COMBINED SINGLE LIMIT
1,000,000
BODILY INJURY Perperson)
BODILY INJURY Per accident
PROPERTY DAMAGE
Per.cadent
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
AGGREGATE
DED I I RETENTION $
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y
ANY PROPRIETORlPARTNER/EXECUTIVE n
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) �I
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
4076606
01/01/2018
01/01/2019
X PER OTH-
STATUTE ER
1
E.L. EACH ACCIDENT
1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
1,000,000
$
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space is required)
RE: City of Ft. Collins is hereby added as additional Insured with regards general liability & automobile liability coverage per written contract.
City of Ft. Collins
P.O. Box 580
Ft. Collins, CO 80522-0580
LAIVLCL -1A 11VIV
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
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