HomeMy WebLinkAboutJ & R ELECTRIC INC - INSURANCE CERTIFICATE (4)A111,I CERTIFICATE OF LIABILITY INSURANCE
FDATE 11/15/D/YYYY)
11/152016
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 endorsements .
PRODUCER
FEDERATED MUTUAL INSURANCE COMPANY
HOME OFFICE: P.O. BOX 328
CONTACT
NAME: CLIENT CONTACT CENTER
A CNNo Ext : 888-333-4949 E I A/c No): 507-446-4664
E-MAIL
ADDRESS: CLIENTCONTACTCENTER FEDINS.COM
OWATONNA, MN 55060
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A: FEDERATED MUTUAL INSURANCE COMPANY
13935
INSURED 374-201-2
INSURER B:
J & R ELECTRIC INC
4251 S NATCHES CT #E
INSURER C:
INSURER D:
ENGLEWOOD, CO 80110
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 4 REVISION NUMBER: 0
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
INSR
SUBR
WVD
POLICY NUMBER
POLICY EFF
MMIDD/YYYY
POLICY EXP
MMIDD/YYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$1,000,000
CLAIMS -MADE ❑X OCCUR
DAMAGE TO RENTED
PREMISES Ea occurrence
$100,000
MED EXP (Any one person)
EXCLUDED
A
Y
Y
9085825
12/30/2016
12/30/2017
PERSONAL & ADV INJURY
$1,000,000
GEN'L
X
AGGREGATE LIMIT APPLIES PER:
POLICY ❑ PE ❑ LOC
GENERAL AGGREGATE
$2,000,000
PRODUCTS - COMP/OP AGG
$2,000,000
OTHER:
AUTOMOBILE
X
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
Ea a. d.ntI
$1,000,000
BODILY INJURY (Per person)
A
ALL OWNED SCHEDULED
AUTOS AUTOS
N
N
9085825
12/30/2016
12/30/2017
BODILY INJURY (Per accident)
HIRED AUTOS NON -OWNED AUTOS
PROPERTY DAMAGE
Per acciden
X
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE
$3,000,000
A
EXCESS LIAB
CLAIMS -MADE
N
N
9085826
12/30/2016
12/30/2017
AGGREGATE
$3,000,000
DED RETENTION
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y/N
ANY PROPRIETORIPARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED?
NIA
Y
9085827
12/30/2016
12/30/2017
X
PER STATUTE
EER
R
E.L. EACH ACCIDENT
$500,000
E.L. DISEASE - EA EMPLOYEE
$500,000
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L DISEASE -POLICY LIMIT
$500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
SEE ATTACHED PAGE
CERTIFICATE HOLDER CANCELLATION
374-201-2
CITY OF FORT COLLINS
PO BOX 580
FORT COLLINS, CO 80522-0580
40
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
tn. 19RR-91111A ACnPn CnRDnRATInN All riniht< roen d
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: 374-201
LOC #:
ACORO®
ADDITIONAL REMARKS SCHEDULE
Page 1 Of 1
AGENCY
NAMEDINSURED
FEDERATED MUTUAL INSURANCE COMPANY
J & R ELECTRIC INC
4251 S NATCHES CT ##E
ENGLEWOOD, CO 80110
POLICY NUMBER
SEE CERTIFICATE # 4.0
CARRIER
NAIC CODE
SEE CERTIFICATE ## 4.0
EFFECTIVE DATE: SEE CERTIFICATE ## 4.0
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE
THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS,
LESSORS OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR
GENERAL LIABILITY.
GENERAL LIABILITY CONTAINS A WAIVER OF SUBROGATION IN FAVOR OF THE CERTIFICATE HOLDER SUBJECT TO THE CONDITIONS
OF THE BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY ENDORSEMENT.
WORKERS COMPENSATION CONTAINS A WAIVER OF SUBROGATION IN FAVOR OF THE CERTIFICATE HOLDER.
ACORD 101 (2008/01) O 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD