HomeMy WebLinkAboutNEW MEXICO CHAPTER MERIT SHOP - INSURANCE CERTIFICATEACOFdDw - iik� *�� € DATE(MM�DD�YY)
12/08/04
PRODUCER
ADD Risk services, Inc. Of NeW Mexico
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
6000 uptown Blvd NE
AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
Suite 400
Albuquerque NM 87110 USA
CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
PHONE SOS 889-6700 FAX- 505 884-7831
INSURED
INSURER A: Midwest Employers Cas. Co.
'New Mexico Chapter Merit Shop -WC Group
AUI Inc.
INSURERB:
INSURER
P.O. BOX 9825
Albuquerque NM 87119-9825 USA
ORIGINAt
INSURER D:
INSURER E:
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.
INSR
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE(MM\DD\YY)
POLICY EXPIRATION
DATE(MMU)D\YY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
FIRE DAMAGE(Any ,,. fire)
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE O OCCUR
MED EXP (Aov one Perv)n)
PERSONAL& ADV INJURY
GENERAL AGGREGATE
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
PRO -
POLICY 1:1JEC-f LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
ANY AUTO
(E+, uccidem)
BODILY INJURY
ALL OWNED AUTOS
'SCHEDULED AUTOS
( Per Person)
BODILY INJURY
HIRED AUTOS
NON OWNED AUTOS
(Per x6&nl)
PROPERTY DAMAGE
(Per.6&nl)
GARAGE LIABILITY
,AUTO ONLY - EA ACCIDENT
OTHER THAN EA ACC
ANY AUTO
AUTO ONLY
AGG
EXCESS LIABILITY
EACH OCCURRENCE
AGGREGATE
OCCUR 0 CLAIMS MADE
DEDUCTIBLE
RETENTION
A
W'ORKERS COMPENSATION AND
EMPLOYERS'LIABILITY
EW0005487
SIR Deductible $350,000
12/31/04
12/31/05
X
WC srATu-
TORY LIMITS
oTH-
ER
E.L. EACH ACCIDENT
51,000,000
E.L. DISEASE -POLICY LIMIT
$1,000,000
E.L. DISEASE -EA EMPLOYEE
$1,000,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
RE: Pipe Bursting Project
[ ,'q .ti if'r.
,4+ , +777- `„% .'-gym E= .:ii
City of Fort Collins
Purchasing Division
215 N. Mason Street
Fort Collins CO 80522 USA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING COMPANYWILL ENDEAVORTO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
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