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HomeMy WebLinkAboutCOUPER ELECTRIC LLC - INSURANCE CERTIFICATE (12)ACOROa AC� CERTIFICATE OF LIABILITY INSURANCE DATE (MMDD/YYYY) 01/18/2018 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 Jeannie Hulse Ins & Financial Services CONTACT NAME: Jeannie Hulse PWC.HONNo,E Ext); 303-828-4002 FAX No:303-828-4024 State Farm Insurance Companies 525 Briggs St PO Box 1005 t� Erie, CO 80516 E-MAIL ADDRESS: 'eannie.huIse.j68C statefarm.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: State Farm Fire and Casualty Company 25143 INSURED Couper Electric LLC INSURER B : State Farm Mutual Automobile Insurance Company 25178 INSURER C : 1331 Kanemoto Ln ERIE CO 80516 INSURERD: INSURER E : INSURER F : COVERAGES 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY LIMITS A GENERAL LIABILITY ❑ ❑ 96-CR-Z696-6 01/01/2018 01/01/2019 EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENT PREMISES Ea occurrence $ 300,000 X CLAIMS -MADE 17OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 4,000,000 $ X POLICYPRO- LOC JECT B AUTOMOBILE LIABILITY El ❑ EOa BINEDtccidenSINGLE LIMIT $ ANY AUTO 440-4372-A01-06 BODILY INJURY (Per person) $ 1,000,000 BODILY INJURY (Per accident) $ 1,000,000 X ALL OWNED SAUTOS CHEDULED NON -OWNED HIRED AUTOS AUTOS X ENOL 440-3335-A01-06 440-3336-A01-06* 01/01/2018 07/01/2018 PROPERTY DAMAGE Per accident $ 1,000,000 $ UMBRELLA LIAB OCCUR HEI EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICE/MEMBER EXCLUDED? (Mandatory in NH) N / A ElE.L. IWC STATU- X OTH- TORY IMIT ER EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below El El DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Additional auto policy #s: 440-3337-A01-06 440-3338-A01-06 I,Wg11 V 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 REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserves. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 1001486 132849.7 03-01-2012