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HomeMy WebLinkAbout578579 GO UP ELEVATOR INSPECTION SERVICES INC - CONTRACT - AGREEMENT MISC - GO UP ELEVATOR INSPECTION SERVICES INCDocuSign Envelope ID: 81C9E9FF-A68E-43C3-B43F-671C5126CDF8 DocuSign Envelope ID: 81C9E9FF-A68E-43C3-B43F-671C5126CDF8 DocuSign Envelope ID: 81C9E9FF-A68E-43C3-B43F-671C5126CDF8 DocuSign Envelope ID: 81C9E9FF-A68E-43C3-B43F-671C5126CDF8 DocuSign Envelope ID: 81C9E9FF-A68E-43C3-B43F-671C5126CDF8 DocuSign Envelope ID: 81C9E9FF-A68E-43C3-B43F-671C5126CDF8 Assistant City Attorney ll 6/24/2021 Interim City Clerk DocuSign Envelope ID: 81C9E9FF-A68E-43C3-B43F-671C5126CDF8 DocuSign Envelope ID: 81C9E9FF-A68E-43C3-B43F-671C5126CDF8 DocuSign Envelope ID: 81C9E9FF-A68E-43C3-B43F-671C5126CDF8 06/04/2021 RONNIE JL WARD & SON P.O. BOX 12333 DALLAS TX 75225- (214)358-5000 Great American Insurance Company Go Up Elevator Inspection Services, Inc. 10601 S WILDHURST Littleton CO 80126- 16691 Ronald Ward TALLMAN@ronniewardins.com (888)433-0902 X X X MAC130348304A 01/26/2021 01/26/2022 1,000,000 300,000 10,000 1,000,000 4,000,000 4,000,000 Max Annual Aggregate 10,000,000 X X MAC130348304A 01/26/2021 01/26/2022 1,000,000 The general liability policy contains blanket additional insured per the attached elevator contractor plus endorsement. The hired / non owned auto policy's stance on limit of insurance - additional insureds is attached per the elevator contractor auto plus endorsement. AI 006626 PO BOX 580 Fort Collins, CO 80522 - City of Fort Collins ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSR WVD DATE (MM/DD/YYYY) PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) GENERAL LIABILITY AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY $PREMISES (Ea occurrence) CLAIMS-MADE OCCUR MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER:PRODUCTS - COMP/OP AGG $ $PRO-POLICY LOCJECT COMBINED SINGLE LIMIT $(Ea accident) BODILY INJURY (Per person)$ANY AUTO ALL OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $AUTOS (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $$ WC STATU-OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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: CERTIFICATE HOLDER CANCELLATION © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2010/05) CERTIFICATE OF LIABILITY INSURANCE DocuSign Envelope ID: 81C9E9FF-A68E-43C3-B43F-671C5126CDF8 Pinnacol Assurance 7501 E. Lowry Blvd. Denver, CO 80230-7006 Go Up Elevator Inspection Services Inc 10601 S Wildhurst Circle Highlands Ranch, CO 80126 06/04/2021 4172710 04/01/2021 04/01/2022 1,000,000 1,000,000 1,000,000 2180011 City of Fort Collins PO Box 580 Fort Collins, CO 80522 jrector@fcgov.com Pinnacol Assurance Unless otherwise stated in the policy provisions, coverage in Colorado only. DocuSign Envelope ID: 81C9E9FF-A68E-43C3-B43F-671C5126CDF8 CERTIFICATE HOLDER COPY City of Fort Collins PO Box 580 Fort Collins, CO 80522 DocuSign Envelope ID: 81C9E9FF-A68E-43C3-B43F-671C5126CDF8