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HomeMy WebLinkAboutAcord-10/11/2010Ro® CERTIFICATE OF LIABILITY INSURANCE OP ID xiM DATE(MM/DD/YYYY) 09/29/10 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 PDCM Insurance P.O. Box 2597 Waterloo IA 50704 Phone:319-234-8888 Fax:319-234-7702 l.UN t Al. t NAME: Lo, Ext): (A/C, No): ADDRESS: PRODUCER CUSTOMER ID #: BHELE-0 INSURER(S)AFFORDINGCOVERAGE NAIC# INSURED Black Hawk Electrical Co. 1507 Commercial St. Waterloo IA 50702 INSURERA: General Casualty Co. #14-0136 24414 INSURER B : CCXO684892 INSURERC: 05/01/11 INSURER D : $ 1,000,000 INSURER E : PRA MISES (Ea occurrence) INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. INSH LTR TYPE OF INSURANCE AUUL INSR AOI* WVD POLICY NUMBER POLICY 1H- (MM/DDIYYYY) POLICY WU (MM/DD/YYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR ]� CCXO684892 05/01/10 05/01/11 EACH OCCURRENCE $ 1,000,000 X PRA MISES (Ea occurrence) $ 100,000 CLAIMS -MADE X MED EXP (My one person) $ 5 , 000 PERSONAL BADV INJURY $ 1,000,000 X Vol Prop Damage GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 7 POLICY X PROCT LOC JE $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CBA0684895 05/01/10 05/01/11 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ A UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CCU0684893 05/01/10 05/01/11 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5, 000 , 000 DEDUCTIBLE RETENTION $ 10, 000 $ X $ A WORKERSCOMPENSAllON AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIV OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS Y / N N / A CWC0684894 05/01/10 05/01/11 X WCSTATU- OTH- TORY LIMITS ER E.L.EACH ACCIDENT $ 500,000 OO below E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $500,000 A Equipment Floater CIM0708741 05/01/10 05/01/11 Rented/ Leased $25,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Riverfront Stadium Lighting Upgrades. CERTIFICATE HOLDER CANCELLATION WTCI001 City of Waterloo 715 Mulberry Street Waterloo IA 50703 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 © 988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD