HomeMy WebLinkAboutSOUTHPAW PLUMBING LLC - INSURANCE CERTIFICATE (2)ACORbr
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
08/02/2017
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 have ADDITIONAL INSURED provisions or 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(AC
CONTACT
NAME: CLIENT CONTACT CENTER
A CNNo Ext : 888-333-4949 FAX
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 154-351-1
INSURER B:
SOUTHPAW PLUMBING LLC
INSURER C:
7334 S ALTON WAY BLDG 14 STE O
INSURER D:
CENTENNIAL, CO 80112-2320
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 7 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
DDL
INSR
SUBR
WVD
POLICY NUMBER
POLICY EFF
MMIDD/YYYY
POLICY EXP
MM/DD/YYYY
LIMITS
A
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE
I X� OCCUR
BUSINESS OWNER'S LIABILITY
N
N
6050910
08/01/2017
08/01/2018
EACH OCCURRENCE
$1,000,000
AMAGE TO RENTED
PREMISES Ea occurrence)
$100,000
X
MED EXP (Any one person)
GEN'L
X
PERSONAL & ADV INJURY
$1,000,000
AGGREGATE LIMIT APPLIES PER:
PRO -
PRO ❑ LOC POLICY ❑
OTHER:
GENERAL AGGREGATE
$2,000,000
PRODUCTS - COMP/OP AGG
$2,000,000
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
OWNED AUTOS ONLY SCHEDULED
AUTOS
HIRED AUTOS ONLY NON -OWNED
AUTOS ONLY
N
N
6050911
08/01/2017
08/01/2018
COMBINED SINGLE LIMIT
Ea acciden
$1,000,000
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE
Per acciden
A
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
N
N
6050912
08/01/2017
08/01/2018
EACH OCCURRENCE
$1,000,000
AGGREGATE
$1,000,000
DED I I RETENTION
A
WORKERS COMPENSATION Y
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED? ❑
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
N
6050913
08/01/2017
08/01/2018
X
PER STATUTE
OTH-
ER
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE - EA EMPLOYEE
$1,000,000
E.L DISEASE - POLICY LIMIT
$1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required)
CERTIFICATE HOLDER CANCELLATION
154-351-1
CITY OF FORT COLLINS
PO BOX 580
FORT COLLINS, CO 80522-0580
70
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 ////'./��s;'►'f'_"/
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