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HomeMy WebLinkAboutTRACE LLC - INSURANCE CERTIFICATE­­_pW0014110 TRACE-3 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY)07/31/2018 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 918-779-7880 coME CT Sheryl Shuck Vaughan Insurance Group, LLC PHONE 918-779-7880 FAX 918-779-7885 PO Box 52534 (A/C, No, Ext): (A/C, No Tulsa, OK 74152-0534 E-MAIL . ss@vaughanins.com Mike Harper INSURER A:Ace Property & Casualty Ins Co 20699 INSURED Trace LLC INSURER B : Great Northern Insurance Co 20303 Attn: Jimmy Dixon INSURER C : Chubb National Insurance Compa 10052 7107 S. Yale, Ste 348 Tulsa, OK 74136-6308 INSURER D INSURER E : INSURER F r`C07111=1/`ATF KII IaARC17• RFVICInkI All IMRFR- 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 SUB POLICY NUMBER POLICY EFF POLICY EXP D MMI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE [X] OCCUR X TECOKD528241991 08/21/2018 08/21/2019 DAMAGE TO RENTED $ 1,000,000 X MED EXP (Any oneperson) $ 51000 Hired & Non -Owned TECOKD528241991 08/21/2018 08/21/2019 Auto Liability PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY JECT LOC $ OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 BODILY INJURY Perperson) $ ANY AUTO 73602834 08/21/2018 08/21/2019 BODILY BODILY INJURY Per accident $ X OWNED SCHEDULED AUTOS ONLY AUTOS PROPERTY DAMAGE er accident (per. $ AUTOS ONLY AUOTOS ONE A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 EXCESS LIAB CLAIMS -MADE UMBOKD528241141 08/21/2018 08/21/2019 AGGREGATE $ 4,000,000 riDED I X I RETENTION$ -Q- $ _ C WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITY YIN 71766624 08/21/2018 08/21/2019 AN ECUTIVE E.L. EACH ACCIDENT 11000,000 OFFICER/MEIMBEER/EXCLUDED? ❑ N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS beIOs _ _ _ _ E.L. DISEASE-POLICY_LIMIT 1,000,000 �_ DittSyyCRI FOrtFCOhIATIQNns is Sri �A(1C71i10nall InSUreQ Wltll' �estpects l�enera�ule, may be attached If more space is required) Liability if required or agreed to in a written contract subject to all provisions and limitations of the insurance policy. CITYF-1 City of Fort Collins PO Box 580 Fort Collins, CO 80522-0580 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 �IIAI7- ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD