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HomeMy WebLinkAboutCertificate of Liabilty Insurance A��RD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDYYYY) 8/31/2015 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. PORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to , 1e 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 CONTACT Lori Frerichs NAME First Insurance Services/The ACCEL Group PHONE (319)352-2880 FAX IA/C No.Extl- (A/C.Nol: (319)352-2075 300 E Bremer Ave AODRIess:LFrerichs@AccelAdvantage.com P.O. Box 269 INSURER(S)AFFORDING COVERAGE NAIL# Waverly IA 50677 INSURER A:United Fire & Casualty 13021 INSURED INSURER a:Cincinnati Insurance Co. 10677 LIFE LINE EMERGENCY VEHICLES INC SEE SPECEND INSURER C:Lafayette Insurance Co. 18295 PO BOX 299 INSURER D: P.O. Box 299 INSURERS: SUMNER IA 50674-0299 INSURER F: COVERAGES CERTIFICATE NUMBER:CL14123006182 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER ,(MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurrence) $ 100,000 A CLAIMS-MADE X OCCUR 60026795 1/1/2015 1/1/2016 MED EXP(Any one person) $ 5,000 PERSONAL BADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY n PRO- n JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 60026745 1/1/2015 1/1/2016 BODILY INJURY(Per accident) $ AUTOS _ AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS _ AUTOS X 21 (Per accident) Medical payments $ 5,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 9,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 9,000,000 DED RETENTION$ EUP0059004 1/1/2015 1/1/2016 $ C WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY ,f/N X TORY LIMITS FR ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ 100,000 (Mandatory in NH) 30303136 1/1/2015 1/1/2016 E.L.DISEASE-EA EMPLOYEE $ 100 000 If yes,describe under , DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 A Garage Keepers 500,000/1,000,000 Direct primary 60026745 1/1/2015 1/1/2016 1,000 comp/2,500 coilded. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Waterloo ACCORDANCE WITH THE POLICY PROVISIONS. 715 Mulberry Street Waterloo, IA 50703 AUTHORIZED REPRESENTATIVE ,Y ^_ Katie McGlaun/KATIEMx �-'t�-:,_�-_ S _..... ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005)01 The ACORD name and logo are registered marks of ACORD