HomeMy WebLinkAboutTRI-STATE GENERATION & TRANSMISSION ASSN INC - INSURANCE CERTIFICATE (2)RTIFICATE OF INSURANCE 12/29/2C
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).
THIS IS TO CERTIFY THAT: Tri-State Generation & Transmission Assn, Inc
P.O. Box 33695
Denver, CO 80233-0695
IN/ FEDERATED RURAL ELECTRIC
.,,INSURANCE EXCHANGE
NAIC:11118
P.O. Box 15147, Lenexa, KS 66285-5147
(913) 541-0150 fax (913) 541-9004
www.federatedrura1.com
IS, AT THE ISSUE DATE OF THIS CERTIFICATE, INSURED BY THE COMPANY UNDER THE POLICY(IES) LISTED BELOW. 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.
TYPE OF INSURANCE
POLICY NUMBER
POLICY DATES
LIMITS ($)
GENERAL LIABILITY
EACH OCCURRENCE 1
$1,000,000
DAMAGE TO RENTED PREMISES
$1,000,000
COMMERCIAL GENERAL LIABILITY
MED EXP (PER PERSON)
$1,000
OCCURRENCE -BASIS
PERSONAL & ADV INJURY
$1,000,000
COMPREHENSIVE FORM
1/1/2018
PREMISES / OPERATIONS
05 ARB 006-18
t0
UND / EXPLOSION & COLLAPSE
1/1/2020
PRODUCTS / COMP OPS
CONTRACTUAL
BROAD -FORM PROPERTY DAMAGE
NO GENERAL AGGREGATE
AUTOMOBILE
1/1/2018
COMBINED SINGLE LIMIT
ANY AUTO
05 ARB 006-18
t0
(EACH ACCIDENT)
$1,000,000
COMP DEDUCTIBLE
$1,000
HIRED & NON -OWNED AUTO
1/1/2020
COLLISION DEDUCTIBLE
$1,000
GARAGE LIABILITY (ANY AUTO)
1/1/2018
PROPERTY LIMIT
$1,318,486,171
ALL-RISK BLANKET PROPERTY
05 ARB 006-18
to
1/1/2020
PROPERTY DEDUCTIBLE
$50,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EQUIPMENT / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
See attached Miscellaneous Endorsement - Easement to access property - Richard Lake Substation.
CERTIFICATE HOLDER:
CANCELLATION:
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES
City of Fort Collins
y
BE CANCELLED BEFORE THE EXPIRATION DATE
Real Estate Services Manager
THEREOF, NOTICE WILL BE DELIVERED IN
PO Box 580
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE:
Ft. Collins, CO 80522-0580
FREIE Cert v.8/10
MFEDERATED RURAL ELECTRIC
.,INSURANCE EXCHANGE
This endorsement changes the policy.
Please read it carefully.
Miscellaneous Endorsement
Effective 1/1/2018 12:01 a.m. standard time, this endorsement forms a part of
Policy No. 05 ARB 006-18 issued by Federated Rural Electric Insurance Exchange to
Tri-State Generation & Transmission Assn, Inc.
In consideration of the premium charged, Federated and the Insured agree, subject to all
provisions of the policy except as modified herein, as follows:
City of Fort Collins is added as an additional insured only with respect to liability caused, in
whole or in part, by operations performed by, or on behalf of, the policyholder. Liability
caused by the sole negligence, intentional act or omission of the additional insured is not
covered.
Federated will provide 30 days notice to the additional insured of policy cancellation or
material coverage changes to the mailing address, email address or facsimile phone
number shown on the latest certificate of insurance issued to the additional insured.
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