Cooling COL.tif Client #: 64902 8MASTSER
ACORD DATE (MM /DD/YYYY)
CERTIFICATE I I INSURANCE 04/01/10
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Willis of Colorado, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
720 South Colorad ul and HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 60ON
Denver, CO 80246 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: Nautilus Insurance Company 17370
Cooling Tower Depot, Inc. INSURER B: Arch Specialty Insurance Company 21199
651 Corporate Circle, Suite 206 INSURER C: Zurich American Insurance 16535
Golden, CO 80401 INSURER D: Travelers Property Casualty Company 36161
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INSURER E: j
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR DD' POLICY EFFECTIVE POLICY EXPIRATION
LTR INSR TYPE OF INSURANCE POL ICY NUMBER DATE MM /DD/YY DATE MM /DD/YY LIMITS
A GENERAL LIABILITY BKO01188801 04/01110 04/01111 EACH OCCURRENCE $1,000,000
DAMAGE TO RENTED
X COMMERCIAL GENERAL LIABILITY PREMISES (a occ urrence) $100,000
CLAIMS MADE ® OCCUR MED EXP (Any one person) $10,000
PERSONAL &ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000
GEN'L AGGREGATE LIMITAPPLIES PER: PRODUCTS - COMP /OP AGG s2,000,000
ri POLICY a PRO LOC
JECT
C AUTOMOBILE LIABILITY BAP488684800 04/01/10 04101/11 COMBINED SINGLE LIMIT
X ANY AUTO (Ea accident) $1,000,000
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person) $
X HIRED AUTOS BODILY INJURY
X NON -OWNED AUTOS
(Per accident) $
X Hired Phy Dam PROPERTY DAMAGE
Subj to Ded. (Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
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AUTO ONLY: AGG $
B EXCESS /UMBRELLA LIABILITY ULP003006601 04101110 04101/11 EACH OCCURRENCE $10000000
X OCCUR FI CLAIMS MADE AGGREGATE $10,000,000
DEDUCTIBLE $
X RETENTION $ 10,000 $
C WORKERS COMPENSATION AND WC488684900 04/01110 04/01/11 X OR s LIM o ER
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EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUDED? E.L. DISEASE - EA EMPLOYEEI $1,000,000
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If yes, describe under
SPECIAL PROVISIONS below E.L. DISEASE- POLICY LIMIT $1,000,000
D OTHER Leased or QT660947513443 04/01/10 04101/11 $250,000 Limit j
Rented Equipment $100,000TempLocFtransit
$5,000 Deductible
DESCRIPTION OF OPERATIONS / LOCATIONS! VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
This Certificate of Insurance represents coverage currently in effect and
may or may not be in compliance with any written contract.
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* The following cancellation conditions always apply: j
(See Attached Descriptions)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Blair DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Vin* DAYS WRITTEN
218 South 16th St. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Blair, NE 68008 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2001108) 1 of 3 #M668482 8NPER 0 ACORD CORPORATION 1988