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HomeMy WebLinkAboutC24-178 Intermountain SweeperDocuSign Envelope ID: F99F0A05-9055-4AFE-908F-0657D8084894 DocuSign Envelope ID: F99F0A05-9055-4AFE-908F-0657D8084894 DocuSign Envelope ID: F99F0A05-9055-4AFE-908F-0657D8084894 Drew Winegar County Manager Jeff Shroll SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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 endorsement(s). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 4/3/2024 Arthur J.Gallagher Risk Management Services,LLC 6300 South Syracuse Way Suite 700 Centennial CO 80111 Nathan Kathol 303-889-2532 Nathan_Kathol@ajg.com Travelers Indemnity Company 25658 EAGLCOU-04 Charter Oak Fire Insurance Company 25615EagleCounty,Colorado P.O.Box 850 500 Broadway Eagle CO 81631 Travelers Property Casualty Co of America 25674 Zurich American Insurance Company 16535 Pinnacol Assurance Company 41190 1655957083 A X 1,000,000 X 300,000 Excluded 1,000,000 1,000,000 X ZLP91N37268 1/1/2024 1/1/2025 1,000,000 B 1,000,000 X 81091N37268 1/1/2024 1/1/2025 C X X 9,000,000ZUP91N3727A1/1/2024 1/1/2025 9,000,000 X 10,000 E X42209231/1/2024 1/1/2025 1,000,000 1,000,000 1,000,000 D Property ERP721349803 1/1/2024 1/1/2025 Policy Limit Earthquake Flood $100,000,000 $25,000,000 $10,000,000 Flood Zone A Limit -$1,000,000 $50,000 Policy Deductible except $100,000 for Earthquake,$500,000 for Flood and $1,000,000 for Flood Zone A RE:VIN:4GTM7F1B49F700094 |S.N.:201102SNQ62578BAH |Miles:24,399 |Hours:3,199 Sweeper Intermountain Sweeper Co 6972 So Airport Road, West Jordan UT 84084 DocuSign Envelope ID: F99F0A05-9055-4AFE-908F-0657D8084894