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HomeMy WebLinkAboutHIGH PLAINS - INSURANCE CERTIFICATEA-c RD CERTIFICATE OF LIABILITY INSURANCE OP ID P DATE (MMIDDIYY) GH-13 04/02/03 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Brown & Brown Inc - Ft Collins HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 125 S . Howes, 5th Floor ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fort Collins CO 80522-226 Phone:970-482-7747 Fax:970-484-4165 INSURERS AFFORDING COVERAGE INSURED I INSURER A: MOUNTAIN STATES MUTUAL High Plains Mechanical Systems INSURER B: PINNACOL AS ( At�n: Judy Auer INSURERC: 2020 Airway Avenue INSURER D: Ft. Collins CO 80524 — 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. INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YY POLICY EXPIR TIONLIMITS DATE MMIDDtYYTY rGENERALLIABILITY L GENERALLIABILITV MADE •- 1 OCCUR CPP007999001 12/31/02 12/31/03 EACH OCCURRENCE $ 1,000,000 FIRE DAMAGE (Anyonefira) $ 100,000 MED EXP (Any one person) $ 10,000 PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 E LIMIT APPLIES PER: POLICY n PRO- JECT M LOC PRODUCTS - COMP/OP AGG $2,000,000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULEDAUTOS HIRED AUTOS NON -OWNED AUTOS BAP007999801 12/31/02 12/31/03 COMBINED SINGLE LIMIT (Ea accident) $ 1000 r ,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ A EXCESS LIABILITY X OCCUR CLAIMSMADE DEDUCTIBLE X RETENTION $ 10000 UMB007999801 12/31/02 12/31/03 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 4052379 04/01/03 ----- 04/01/04 X TORY LIMITS ER E.L. EACH ACCIDENT $ 500000 E.L. DISEASE - EA EMPLOYEE $ 5 0 0 0 0 0 E.L. DISEASE -POLICY LIMIT 1 $ 5000QQ OTHER T__ - -7 I DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSION$ ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Fax: 221-6707 Reissued 4-1-03 CERTIFICATE HOLDER I N I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION CITYFTC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Fort Collins DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Attn : John Stevens NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Building & Inspect Div P O Box 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Fort Collins CO 80522 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25-S (7197) ©ACORD CORPORATION 1988