HomeMy WebLinkAbout102715 HAHN PLUMBING & HEATING INC - INSURANCE CERTIFICATE (3)®
ACORO
16.�- CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
07/162018
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
CONTACT
NAME: CLIENT CONTACT CENTER
PHOE
A CNNo Exc : 888-333-4949 a/c No): 507-446-4664
ADMDRESS: CLIENTCONTACTCENTER FEDINS.COM
OWATONNA, MN 55060
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A: FEDERATED MUTUAL INSURANCE COMPANY
13935
INSURED 314-001-9
INSURER B: FEDERATED SERVICE INSURANCE COMPANY
28304
HAHN PLUMBING & HEATING INC
INSURER C:
PO BOX 1924
FORT COLLINS, CO 80522-1924
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 21 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
MMIDDIYYYY
POLICY EXP
MMIDDIYYYV
LIMITS
A
COMMERCIAL GENERAL LIABILITY
OCCUR
BUSINESS OWNER'S LIABILITY
Y
N
9430480
08/31/2018
08/31/2019
EACH OCCURRENCE
$1,000,000
DA AGE ToCLAIMS-MADE
PREMISES Ea occur RENTEence
$101),000
X
MED EXP (Any one person)
$5,000
GEN'L
�OTHER:
PERSONAL & ADV INJURY
$1,000,000
AGGREGATE LIMIT APPLIES PER:
POLICY ❑ PRO ❑
JECT LOC
GENERAL AGGREGATE
$2,000,000
PRODUCTS - COMP/OP AGG
$2,000,000
B
AUTOMOBILE
X
LIABILITY
ANY AUTO
OWNED AUTOS ONLY SCHEDULED
SAUTOSCHEDULED
HIRED AUTOS ONLY NON -OWNED
AUTOS ONLY
N
N
9430481
08/31/2018
08/31/2019
COMBINED SINGLE LIMIT
Ea accident
$1,000,000
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE
Per accident
A
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
N
N
9430482
08/31/2018
08/31/2019
EACH OCCURRENCE
$1,000,000
AGGREGATE
$1,000,000
DED I I RETENTION
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
It yes, describe under
DESCRIPTION OF OPERATIONS below
N 1 A
PER STATUTE
OTH-
ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L DISEASE - POLICY LIMIT
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required)
CITY OF FORT COLLINS IS NAMED AS ADDITIONAL INSURED ON THE BUSINESSOWNERS LIABILITY POLICY.
CERTIFICATE HOLDER CANCELLATION
314-001-9
CITY OF FORT COLLINS UTILITIES DEPARTMENT
PO BOX 580
FORT COLLINS, CO 80522-0580
21 0
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
4,
O 1988-2015 ACORD CORPORATION. All rlgnts reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
Additional Insured Copy
FEDERATED INSURANCE COMPANIES
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR
SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR
AUTHORIZATIONS
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS LIABILITY COVERAGE FORM
SCHEDULE
State Or Governmental Agency or Subdivision or Political Subdivision:
CITY OF FORT COLLINS UTILITIES DEPARTMENT
PO BOX 580
FORT COLLINS CO 80522
The following is added to Paragraph C. Who Is An
Insured:
4. Any state or governmental agency or subdivision
or political subdivision shown in the Schedule is
also an insured, subject to the following
provisions:
a. This insurance applies only with respect to
operations performed by you or on your
behalf for which the state or governmental
agency or subdivision or political subdivision
has issued a permit or authorization.
Insured:
HAHN PLUMBING & HEATING INC
PO BOX 1924
FORT COLLINS CO 80522
b. This insurance does not apply to:
(1) "Bodily injury", "property damage", or
"personal and advertising injury" arising
out of operations performed for the state
or municipality; or
(2) "Bodily injury" or "property damage"
included within the "products -completed
operations hazard".
Place of Issue:
FEDERATED MUTUAL INSURANCE COMPANY
Home Office
121 East Park Square
Owatonna, MN 55060
(507) 455-5200
Includes copyrighted material of Insurance Services Office, Inc., with its permission_
BP-F-254 (08-11) Policy Number: 9430480 Transaction Effective Date: 08-31-2018