HomeMy WebLinkAboutMCLEMORE PUMP - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE OPID $
DATE (MMIOOIYYYY)
MCLEM-1
07 17 03
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
CRS Insurance Brokerage
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
6600 E. Hampden Ave., 2nd Flr.
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Denver CO 80224
Phone:303-996-7800 Fax:303-996-7850
INSURERS AFFORDING COVERAGE
NAIC#
INSURED
INSURER A: Mountain States Insurance Cc.
INSURER B: Pinnacol Assurance
McLemore Pump, Inc.
MPI LLC
6346 Downing Street
Denver CO 80216
INSURER C:
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 EFFECTIVE
DATE MMIDD
POLICY EXPIRATION
DATE MMID
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE X❑ OCCUR
X Blkt Addl Insured
CPP009518301
07/18/03
07/18/04
EACH OCCURRENCE
$ 1, 000, 000
PREMISES(EeaarenwI
$100,000
MED EXP(Any one person)
$ 10, 000
PERSONAL BADVINJURY
$1,000,000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY jECT LOC
PRODUCTS -COMPIOP AGO
s2,000,000
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
BAP009518301
07/18/03
07/18/04
COMBINED SINGLE LIMB
(Ea accident)
$1, 000, 000
X
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE LLAEIII Y
ANY AUTO
AUTO ONLY- EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
A
EXCESSIUMBRELLA LIABILITY
X I OCCUR CLAIMSMADE
0DEDUCTIBLE
x RETENTION $10 , 0 0 0
UMB009518301
07/18/03
07/18/04
EACH OCCURRENCE
$ 1, 000, 000
AGGREGATE
$ 1, 000, 000
S
$
$
B
WORKERS COMPENSATION AND
EMPLOYERS'LA4BILITY
ANY PROPRIETORIPARTNER/EXECUTrVE
OFFICERIMEMBER EXCLUDED?
H yes, describe under
SPECIAL PROVISIONS below
4046150
07/01/03
07/01/04
X TORY UNITS ER
E.L. EACH ACCIDENT
$1000000
E.L. DISEASE - EA EMPLOYEE
$1000000
E.L. DISEASE -POLICY LIMIT
I $1000000
A
OTHER
Building
special Form
CPP009518301
I
07/18/03
I
07/18/04
R/C 1,083,954
Ded. 500
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
VCR I Ir14^a C n uLYCR
CI FTCOL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO!
City of Fort Collins DATE THEREOF, THE ISSUING INSURER WALL ENDEAVOR TO AWL 30 DAYS WRITTEN
At tn: James B O'Neill 11 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Purchasing Division IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
256 vilest Mountain
Fort Collins CO 80522 REPRESENTATIVES.
25
C(4]