HomeMy WebLinkAboutMCLEMORE PUMP MPI LLC - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE OP ID S DATE (MM DD/YYYY)
MCLEM-1 06 27 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
McLemore Pump, Inc.
'I LLC
634� Downing Street
Denver CO 80216
I016YI4:7a1H MI-1
INSURERS AFFORDING COVERAGE NAIC #
INSURER A: Travelers Property & Casual
INSURERS: Pinnacol Assurance
INSURER C: U
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.
LTR
INSR
TYPE OF INSURANCE
POLICY NUMBER
DATE MM/DD/YY
DATE MM/DDIYY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE FX� OCCUR
6801899W234
07/18/02
07/18/03
PREMISES(EaoEccuence)
s300,000
MED EXP (Any one person)
$ 5,000
X Blkt Addl Insured
PERSONAL B ADV INJURY
$ 1, 000, 000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMP/OP AGG
s2,000,000
17 POLICY PRO-
JECT LOC
Em Ben,
1,000,000
A
AUTOMOBILE
LIABILITY
ANY AUTO
8101899W302
07/18/02
07/18/03
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
'
$
AUTO ONLY: AGG
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
X OCCUR CLAIMSMADE
CUP1899W271
07/18/02
07/18/03
AGGREGATE
$ 1, 000, 000
$
0DEDUCTIBLE
X RETENTION $5,000
$
B
WORKERS COMPENSATION AND
EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
4046150
07/01/03
07/01/04
"
X TW LIMITS ER
E.L. EACH ACCIDENT
S1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1, 0 0 0 , 0 0 0
E.L. DISEASE - POLICY LIMIT
$ 1, 0 0 0 , 0 00
OTHER
A
Building
6801899W234
07/18/02
07/18/03
R/C 1,083,954
Special Form
Ded. 500
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
All Work. Fax 970-221-6707
CIFTCOL
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 30 DAYSWRITTEN
Attn: James B O'Neill 11
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Purchasing Division
256 West Mountain
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Fort Collins CO 80522
REPRESENTATIVES.
AUTHORV.P REPRESENT THE
/1 WnY 40 IGV V rtwo) W AGURL) GORPORATION 1988