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Home My WebLink About110001 HIGH PLAINS MECHANICAL SERVICE - INSURANCE CERTIFICATEFrom: To-i Griscavage At: Brown & Brown of Colorado FaxID: (970) 484-4165 To: City of Ft. Collins Date: 4/4/2011 01:23 PM Page' 2 of 2 .�CORLi� CERTIFICATE OF LIABILITY INSURANCE OPID TG °ATE'MMI°Dm ) �-- 04/04/11 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder Is7n-A-Db7rdNAL INSURED, the policy(les must be en o-f-se—d TsORIMATION 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 plights to the certificate holder in lieu of such endorsement(s). PRODUCER Brown & Brown Inc E: NAMPHONE (,C. No, EA): (A/C, No): 125 S Howes, Sth Floor ADDRESS: P O BOX 2226 Fort Collins CO 80522-2226 CUSTOMERIDC HIGH-13 Phone:970-482-7747 Fax:970-484-4165 INSURERS) AFFORDING COVERAGE Hall INSURED INSURER A: MOUNTAIN STATES MUTUAL 14648 High Plains Mechanical Service Inc. INSURER B: PINNACOL ASSURANCE 41190 INSURER C: Attn: Judy Schlemer 2020 Airway Avenue Ft. Collins CO 80524 - INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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 MY 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. LTR TYPE OF INSURANCE INSR WV POLICY NUMBER (`VLI" WYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Ix I OCCUR CPP007999810 04/01/11 04/01/12 PREMISES (Ea occurrence) $1001000 MED EXP (Any one person) $ 15,000 X BLANKET WOS PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGO $2,000,000 POLICY X PROECT LOC J $ A AUTOMOBILE X LIABILITY ANY AUTO BAP007999810 04/01/11 04/01/12 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY wdulxv (Per person) $ ALL OWNED AIROS BODILY INJURY(Psr accident) $ SCHEDULED AUTOS HIRED AUTOS BLANKET ADDL. INS. BLANKET WOS I(Par PROPERTY DAMAGE eaodimh - $ NONLOWNED AUTOS $ A UMBRELLA LIAR X I OCCUR UMB007999810 04/01/11 04/01/12 EACH OCCURRENCE $1,000,000 EXCESS LIAR CLAIMS -MADE AGGREGATE $ 1,000,000 DEDUCTIBLE $ X RETENTION $ O $ B AND EMPLOYERS'LIABILIN yNN ANY PROPRIETORlPMTNERiE)ECUTIVE OFFICEWMEMSER EXCLUDED? (Mandatory in NH) if yes. describeTIunder IA 40 BNT RAIVCR SuddodATIOI 04/01/11 04/01/12 X TORY LIMITS ER EL EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 EL.DISEASE -POLICY LIMIT. $500,000 OE.s. OF OPERATIONS OelOry DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more apace is required) Fax: 221-6707 Attn: Christine Certificate holder is additional insured under the general liability per form per form UND618 & 033228 as required by written contract - CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITYFTC I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. _.-- _._..._..... City of Fort Collins _-- 281`N^College ^Avenue ^ Tyler B. Allen reserved, ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD From: To-i Griscavage At: Brown & Brown of Colorado FaxID: (970) 484-4165 To: City of Ft. Collins Date: 4/4/2011 01:23 PM Page' 2 of 2 .�CORLi� CERTIFICATE OF LIABILITY INSURANCE OPID TG °ATE'MMI°Dm ) �-- 04/04/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder Is7n-A-Db7rdNAL INSURED, the policy(les must be en o-f-se—d TsORIMATION 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 plights to the certificate holder in lieu of such endorsement(s). PRODUCER Brown & Brown Inc E: NAMPHONE (,C. No, EA): (A/C, No): 125 S Howes, Sth Floor ADDRESS: P O BOX 2226 Fort Collins CO 80522-2226 CUSTOMERIDC HIGH-13 Phone:970-482-7747 Fax:970-484-4165 INSURERS) AFFORDING COVERAGE Hall INSURED INSURER A: MOUNTAIN STATES MUTUAL 14648 High Plains Mechanical Service Inc. INSURER B: PINNACOL ASSURANCE 41190 INSURER C: Attn: Judy Schlemer 2020 Airway Avenue Ft. Collins CO 80524 - INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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 MY 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. LTR TYPE OF INSURANCE INSR WV POLICY NUMBER (`VLI" WYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Ix I OCCUR CPP007999810 04/01/11 04/01/12 PREMISES (Ea occurrence) $1001000 MED EXP (Any one person) $ 15,000 X BLANKET WOS PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGO $2,000,000 POLICY X PROECT LOC J $ A AUTOMOBILE X LIABILITY ANY AUTO BAP007999810 04/01/11 04/01/12 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY wdulxv (Per person) $ ALL OWNED AIROS BODILY INJURY(Psr accident) $ SCHEDULED AUTOS HIRED AUTOS BLANKET ADDL. INS. BLANKET WOS I(Par PROPERTY DAMAGE eaodimh - $ NONLOWNED AUTOS $ A UMBRELLA LIAR X I OCCUR UMB007999810 04/01/11 04/01/12 EACH OCCURRENCE $1,000,000 EXCESS LIAR CLAIMS -MADE AGGREGATE $ 1,000,000 DEDUCTIBLE $ X RETENTION $ O $ B AND EMPLOYERS'LIABILIN yNN ANY PROPRIETORlPMTNERiE)ECUTIVE OFFICEWMEMSER EXCLUDED? (Mandatory in NH) if yes. describeTIunder IA 40 BNT RAIVCR SuddodATIOI 04/01/11 04/01/12 X TORY LIMITS ER EL EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 EL.DISEASE -POLICY LIMIT. $500,000 OE.s. OF OPERATIONS OelOry DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more apace is required) Fax: 221-6707 Attn: Christine Certificate holder is additional insured under the general liability per form per form UND618 & 033228 as required by written contract - CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITYFTC I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. _.-- _._..._..... City of Fort Collins _-- 281`N^College ^Avenue ^ Tyler B. Allen reserved, ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD