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HomeMy WebLinkAboutCOUPER ELECTRIC LLC - INSURANCE CERTIFICATE (10)A'C ® DATE (MY) CERTIFICATE OF LIABILITY INSURANCE 12/21120171/2017 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 CONTACT Jeannie Hulse Ins & Financial Services NAME: Jeannie Hulse State Farm Insurance Companies MA L ; 303-828-4002 FAX No: 30 28-4 24 ' 525 Briggs St PO Box 1005 ADDRESS: eannie.hulse.' 8 statefarm.com Erie, CO 80516 INSURE S AFFORDING COVERAGE NAIC 0 A INSURER A: State Farm Fire and Casualty Company257 INSURED Couper Electric LLC INSURERS: 1331 Kanemoto Ln INSURERC: ERIE CO 80516 INSURER0: INSURER E : INSURER F COVFRAGES CFRTIFICATF NUMBFR- 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 LTR TYPE OF INSURANCE A U POLICY NUMBER POLICY EFF MMI POLICY EXP MMID LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY X I CLAIMS -MADE 7 OCCUR ❑ ❑ 96-CR-Z696-6 01/01/2018 01/01/2019 EACH OCCURRENCE $ 2,000,000 I DAMAGE To RE14TED PREMISES Ea occurrence $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- LOC PRODUCTS - COMP/OP AGG $ 4,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTOS AUTOS ENOL � MIN LE LIMI Ea accidccid nent $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROP reOPER DAMAGE $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ TI—DEED 1 1 RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVEE OFFICEIMEMBER E,�jUfD? ❑ " ...a104"?'4"' If yes, describe un, NIA -- - O STATU- % OTH- TRY UM TER E.L. EACH ACCIDENT $ F 1 n-Qr ACF - FA FMDI r)YFr S E.L. DISEASE - POLICY LIMIT -- --- $ '91 . I __ - ___ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) l;tK 1 INI A 1 t MULUtK City of Fort Collins PO 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 ©190-2010 ACORD CORPORATION. All rights reserved- ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 1001486 132849.7 03-01-2012