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HomeMy WebLinkAboutENGINEERED STRUCTURES INC - INSURANCE CERTIFICATE (3)AC� a 78/28/2017 TE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 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 M. Naomi Plumley Y _ The Leavitt Group of Boise, Inc. PNONE Ex : (208) 672-6146 tFa. Nc: (208)658-1951 6220 N. Discovery Way, Ste 100 E-MAILs:naomi-plumley@leavitt.com ADDRES INSURERS) AFFORDING COVERAGE NAIC 0 Boise ID 83713 INSURED Engineered Structures, Inc. 3330 E. Louise Drive Suite 300 B:Travelers D: Casual Meridian ID 83642 1 INSURER F : COVERAGES CERTIFICATE NUMRFR-17-18 All States RFVISION NIIMRFR- 25674 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 DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 A CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 300, 000 MED EXP (Any one person) $ 10,000 GL3292147 9/1/2017 9/1/2018 PERSONAL & ADV INJURY $ 11000,000 GEN'L GENERAL AGGREGATE $ 2,000,000 AGGREGATE LIMIT APPLIES PER: POLICY JEI° a LOC PRODUCTS - COMP/OPAGG $ 2,000,000 Employee Benefits $ 11000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 11000,000 X BODILY INJURY (Per person) $ A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS AL4544799 9/1/2017 9/1/2018 BODILY INJURY (Per accident) $ X PerOa cidentDAMAGE $ NON -OWNED HIRED AUTOS AUTOS Uninsured motorist BI-sin le $ X UMBRELLA LAB OCCUR EACH OCCURRENCE $ 10, 000, 000 AGGREGATE $ 10, 000, 000 B EXCESS LIAB CLAIMS -MADE DED I X I RETENTION$ 10,000 $ ZUP71M6429217NF 9/1/2017 9/1/2018 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 11000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIC (Mandatory in MBER EXCLUDED? ( rY � ) N/A WC25893627 9/1/2017 9/1/2018 E.L. DISEASE- EA EMPLOYE $ 11000,000 if yes, describe under DESCRIPTION OF OPER4TiCNS bc!ow E.L. DISEASE - POLICY LIMIT $ 1,000,000 A California WC WC25893628 9/1/2017 9/1/2018 LGB CA Lic #OE16971 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION City of Fort Collins 300 La Porte Ave Fort Collins, CO 80521 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 Dwayne Speegle/NAPLUM ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)