Central_power_Systems___Services_LLC_-_General-Auto-Umbrella-Workers_Comp_Exp_07.01.24.pdf

10/30/2023

Assured Partners of Missouri, LLC 4435 Main St, 4th Floor

Kansas City MO 64111

Danna Porter 913-359-8213 (913)322-2801 danna.porter@assuredpartners.com

Central Power Systems & Services LLC 9200 Liberty Drive

Liberty MO 64068

Travelers Indemnity Company 25658 Travelers Ind Co of CT 25682 Travelers Indem Casualty Co of America 25666 Travelers Prop & Casualty Co of America 25674 Travelers Casualty & Surety Co of Amer 31194

CL236132289

A

X

X X Sudden & Acc Pollution

X Contractual

X

X Y Y-630-2D638114-23 7/1/2023 7/1/2024

1,000,000

100,000

5,000

1,000,000

2,000,000

2,000,000

Employee Benefits 1,000,000

B X

X X Hired Car PD

X X Garagekeepers

X Y 810-6P387493-23 7/1/2023 7/1/2024

Comp & Coll Ded - $3,000

1,000,000

Medical payments 5,000

C

X X

X 0 X Y CUP-2J920797-23 7/1/2023 7/1/2024

5,000,000

5,000,000

D N

UB-7K47620A-23 7/1/2023 7/1/2024

X

1,000,000

1,000,000

1,000,000

A Leased/Rented Equip/Property Y-630-2D638114-23 7/1/2023 7/1/2024 Limit 1,000,000

E Professional, Cyber, Crime 105570059 7/1/2023 7/1/2024 Limit 2,000,000

Certificate Holder is an additional insured for General Liability Including products-completed operations per policy form CGD2460419. Primary and Non-Contributory coverage for certificate holder per policy form CGT1000219. Waiver of Subrogation applies to the certificate holder per policy form CGD4580219.

Certificate Holder is an Additional Insured for Auto Liability per policy form CAT3530215. Waiver of Subrogation applies to the certificate holder for Auto Liability per policy form CAT3530215. 30 days written notice of cancellation.

State of Arizona Department of Emergency and Miltary Affairs 5636 East McDowell Road Bldg M5800 Phoenix, AZ 85008-3495 robert.coleman@azdema.gov

Matthew Schloegel/DSP

Y

The ACORD name and logo are registered marks of ACORD

CERTIFICATE HOLDER

© 1988-2014 ACORD CORPORATION. All rights reserved.

ACORD 25 (2014/01)

AUTHORIZED REPRESENTATIVE

CANCELLATION

DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE

LOCJECT

PRO-

POLICY

GEN'L AGGREGATE LIMIT APPLIES PER:

OCCURCLAIMS-MADE

COMMERCIAL GENERAL LIABILITY

PREMISES (Ea occurrence) $

DAMAGE TO RENTED

EACH OCCURRENCE $

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GENERAL AGGREGATE $

PRODUCTS - COMP/OP AGG $

$RETENTIONDED

CLAIMS-MADE

OCCUR

AGGREGATE $

EACH OCCURRENCE $UMBRELLA LIAB

EXCESS LIAB

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

INSR

LTR TYPE OF INSURANCE POLICY NUMBER

POLICY EFF

(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY) LIMITS

PER

STATUTE

OTH-

ER

E.L. EACH ACCIDENT

E.L. DISEASE - EA EMPLOYEE

E.L. DISEASE - POLICY LIMIT

ANY PROPRIETOR/PARTNER/EXECUTIVE

If yes, describe under DESCRIPTION OF OPERATIONS below

(Mandatory in NH)

OFFICER/MEMBER EXCLUDED?

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY Y / N

AUTOMOBILE LIABILITY

ANY AUTO

ALL OWNED SCHEDULED

HIRED AUTOS

NON-OWNED

AUTOS AUTOS

AUTOS

COMBINED SINGLE LIMIT

BODILY INJURY (Per person)

BODILY INJURY (Per accident)

PROPERTY DAMAGE $

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.

INSD

ADDL

WVD

SUBR

N / A

(Ea accident)

(Per accident)

OTHER:

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).

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

INSURED

PHONE

(A/C, No, Ext):

PRODUCER

ADDRESS:

E-MAIL

FAX

(A/C, No):

CONTACT

NAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INSURER(S) AFFORDING COVERAGE

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

INS025 (201401)