HomeMy WebLinkAboutOMEGA ELECTRIC - INSURANCE CERTIFICATEClient*, 21639
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ACORD- CERTIFICATE OF LIABILITY INSURANCE
(MWDDNYYY)
09/TE
05/03
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
HRH of Colorado
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
720 S. Colorado Blvd Ste PH N
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. Box 469025
Denver, CO 80246-9025
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
INSURER A: Mountain States Insurance Grp
31194
Omega Electric, Co.
INSURER B: Pinnacol Assurance
Wayne
P.O. Box 190
INSURER C:
Gill, CO 80624-0190
INSURER D:
INSURER E:
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.
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY DTIVE
E IMMID
PDEDfION
ATMID
LIMITS
A
GENERAL LIABILITY
CPPOO9528801
07/25/03
07/25/04
EACH OCCURRENCE
$1 OOO 000
X COMMERCIAL GENERAL LIABILITY
IMAGE TIRE NTED
PREMISES
$100000
CLAIMS MADE O OCCUR
MED EXP (Any one person)
$1 O 000
PERSONAL B ADV INJURY
$1 OOO 000
GENERAL AGGREGATE
s2.000.000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$2000000
17 POLICY JEPROCT LOC
A
AUTOMOBILE
LIABILITY
ANY AUTO
BAP009528801
07/25/03
07/25/04
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
BODILY INJURY
(Per accident)
$
HIREDAUTOS
NON -OWNED AUTOS
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTOONLY: AGG
EXCESSIUMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR CLAIMS MADE
AGGREGATE
$
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND
4019385
05/01/03
05/01/04
STATUB
Y TOwRYLIMIT E
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE
E.L. EACH ACCIDENT
$500000
E.L. DISEASE - EA EMPLOYEE
$500000
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$500000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
"Except 10 day notice for non-payment of premium and Worker's Compensation for any cause
of cancellation"
City of Fort Collins
256 W. Mountain Avenue
Fort Collins, CO 80521
LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL AW DAYS WRITTEN
:E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
iE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
UPS TF�ORIZED REPRESENTATIVE
ACORD 26 (2001/08) 1 of 2 #S175540/M175005 WMC v ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 28S (2001/08) 2 of 2 #S175540JM175005