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HomeMy WebLinkAboutAcord-9/7/2010ACORD, CERTIFICATE OF LIABILITY INSURANCE 08/25/20 0 TYPE OF INSURANCE PRODUCER (563)382-3627 FAX (563)382-2512 A&J Petersburg Agency 106 Coll ege Drive g P 0 Box 290 Decorah, IA 52101 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Voltmer Inc P 0 Box 200 Decorah , IA 52101 INSURERA Cincinnati Insurance Company GENERAL INSURER B: Cincinnati Casualty Company T CPP1051274 INSURER C: 03/01/2011 INSURER D: $ 1,000,000 INSURER E: DAMAGE TO RENTED PRFMIRES (FR ) G 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 CONTRACTOR 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADM INSRE TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY( LIMITS GENERAL UABIUTY COMMERCIAL GENERAL LIABILITY T CPP1051274 03/01/2010 03/01/2011 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED PRFMIRES (FR ) 100,000 ICLAIMS MADE X OCCUR MED EXP (Any one person) $ 5,000 A PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L —I AGGREGATE LIMIT APPLIES PER: POLICY �I jEo. F-1 LOC PRODUCTS - COMP/OP AGG $ 2,000,000 A AUTOMOBILE UABIUTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CAA5869047 03/01/2010 03/01/2011 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE UABIUTY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA UABIUTY CPP1051274 03/01/2010 03/01/2011 EACH OCCURRENCE $ 4,000,000 II OCCUR CLAIMS MADE AGGREGATE $ 4,000,000 DEDUCTIBLE RETENTION $ 0 $ $ X $ B WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below WC2118127 03/01/2010 03/01/2011 X TORY LIMITS ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS PROJECT: CS -TSF -8155(707)--85-076 Traffic Signals- U. S. 63 and Ridgeway Avenue Additional Insured - City of Waterloo, Iowa CERTIFICATE HOLDE City of Waterloo 408 East 6th Street Waterloo, IA 50703 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KII§) IRON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED irqNT < A ACORD 25 (2001/08) ©ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08)