HomeMy WebLinkAboutABC NM CHAPTER AUI INC - INSURANCE CERTIFICATE/DD/YY)
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Services, Inc. of New Mexico
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THISCERTIFICATEIS ISSUED ASAMATTEROFINFORMATIONONLY
n Blvd NE
AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
Albuquerque NM 87110 USA
COVERAGE AFFORDED BY THE POLICIES BELOW.
PHONE SOS 889-6700 FAX• 505 884-7831
INSURERS AFFORDING COVERAGE
INSURED
INSURER A: Midwest Employers Cars. CO.
ABC NM Chapter Merit Shop -WC Group
AUI Inc.
INSURER B:
P.O. BOX 9825
Albuquerque NM 87119-9825 USA
INSURER c:
a
INSURER D: W1 U wit wrier
C
INSURER E:
d
r.
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED
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,NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY
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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 EFFECTIV
POLICY EXPIRATION
LIMITS
a)
DATE(MM\DD\YY)
DATE(MM\DD\YY)
GENERAL LIABILITY
EACH OCCURRENCE
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O�
COMMERCIAL GENERAL LIABILITY
FIRE DAMAGE(Any one tire)
CLAIMS
MADE ❑ IX;CUR
MED EXP (Anv one mmn)
p
n
PERSONAL & ADV INJURY
GENERAL AGGREGATE
GENT AGGREGATE LIMIT APPLIES PER:
PRO-
POLICY LOC
PRODUCTS - COMP/OP AGO
JECT
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v
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
6U
ANY AUTO
(Ea accident)
t
Y
ALL OWNED AUTOS
BODILY INJURY
()
SCHEDULED AUTOS
( Per person)
HIRED AUTOS
BODILY INJURY
NON OWNED AUTOS
(Per accident)
PROPERTY DAMAGE
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
ANY AUTO
OTHER THAN EA ACC
AUTO ONLY:
AGG
EXCESS LIABILITY
EACH OCCURRENCE
OCCUR ❑ CLAIMS MADE
AGGREGATE
DEDUCTIBLE
RETENTION
A
WORKERS COMPENSATION AND
EWC007548
03/01/06
03/01/07
X
WC STATU-
OTH-
EMPLOYERS' LIABILITY
SIR Deductible $350,000
T RY LIMITS
ER
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE -POLICY LIMIT
$1,000,000
_
E.L. DISEASE -EA EMPLOYEE
$1,000,000
OTHER
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DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
RE: Pipe Bursting Project
City Of Fort Collins SHOULD
ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THEXRATION
Purchasing Division DATE
THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
215 N. Mason Street 30
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Fort Collins CO 80522 USA BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATTON OR LIABILITY
OF
ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED
REPRESENTATIVE
_.r - _ .�g-. :•s..;:as: .®.. ._.�, .. a. � DATE(MMJDDJYY
ACORDrM 02/22/06
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 CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
Albuquerque NM 87110 USA COVERAGE AFFORDED BY THE POLICIES BELOW.
PHONE SOS 889-6700 FAx- 505 884-7831 INSURERS AFFORDING COVERAGE
INSURED INSURER A: Midwest Employers Cas. Co.
ABC NM Chapter Merit Shop -WC Group INSURERB:
AUI Inc.
P.O. BOX 9825 INSURER C:' f6
Albuquerque NM 87119-9825 USA
INSURER D: 0 b i4@
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 EFFECTIVEPOLICY
DATE(MMIDDWY)
EXPIRATION
DATE(MMIDD\YY)
LIMITS
GENERAL LIABILMY
EACH OCCURRENCE
FIRE DAMAGE(ARY one fire)
COMMERCIAL GENERALLIABILITY
CLAIMS MADE ❑ OCCUR
MED EXP (Any one Pcrson)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
GENT, AGGREGATE LIMIT APPLIES PER:
PRO -
PRODUCTS -COMP/OP AGO
POLICY 0 JECT M LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
ANY AUTO
(Ea accident)
BODILY INJURY
ALL OWNED AUTOS
SCHEDULED AUTOS
( Per person)
BODILY INJURY
HIRED AUTOS
NON OWNED AUTOS
(Per occident)
PROPERTY DAMAGE
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
ANY AUTO
OTHER THAN EA ACC
AUTO ONLY
AGG
EXCESS LIABILITY
EACH OCCURRENCE
OCCUR ❑ CLAIMS MADE
AGGREGATE
DEDUCTIBLE
RETENTION
A
EMPLOYWORKERSCOMABILITIONAND
EMPLOYERS' LIABILITY
EW0007548
SIR Deductible $350,000
03/01/06
03/01/07
X
WC STATU-
TORY LIMITS
OTH-
ER
E.L. EACH ACCIDENT
$1, OOO, 000
E.L. DISEASE -POLICY LIMIT
$1, 000, 000
E.L. DISEASE -EA EMPLOYEE
$1,000,000
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTJSPECIAL PROVISIONS
RE: Pipe Bursting Project
City of Fort Collins
Purchasing Division
215 N. Mason street
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Fort Collins CO 80522 USA
BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE c- Aae".",
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x
ACQJ46.
DATE(MM/DD/YY)
02/22/06
lneonDD Risk Services, Inc.Of New Mexico A
On
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.
PHONE -(SOS) 889-6700 FAX- SOS 884-7831
INSURERS AFFORDING COVERAGE
INSURED
INSURER A: Midwest Employers Cas. CO.
ABC NM Chapter Merit Shop -WC Group
AUI Inc.
INSURER B:
P.O. BOX 9825
Albuquerque NM 87119-9825 USA
INSURER C:
INSURER D:
INSURER E�.
C
d
'O
H
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY
Y
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 EFFECTIV
DATE(MM\DINYY)
POLICY EXPIRATION
DATE(MM\DD\YY)
LIMITS
O
r`
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE ❑ OCCUR
EACH OCCURRENCE
m
01
n
O
n
FIRE DAMAGE(Aoy one fie)
MED EXP (Any one Person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
GFNL AGGREGATE LIMIT APPLIES PER:
PRO-
POLICY 1:1JECT LOC
..
O
z
PRODUCTS -COMP/OP AGG
v
V
R
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
u
W'
ANY AUTO
ALL OWNED AUTOS
(Ea accident)
t
Y
V
BODILY INJURY
SCHEDULED AUTOS
(Pm person)
BODILY INJURY
HIRED AUTOS
NON OWNED AUTOS
(Per accident)
PROPERTY DAMAGE
(Per accidem)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
ANY AUTO
OTHER THAN EA ACC
AUTO ONLY
AGG
EXCESS LIABILITY
EACH OCCURRENCE
OCCUR F-1 CLAIMS MADE
AGGREGATE
DEDUCTIBLE
RETENTION
A
WORKERS COMPENSATION AND
EMPLOYERS'LIABI.ITY
EW0007548
SIR Deductible $350,000
03/01/06
03/01/07
X
WC STATU-
ORY LIMITS
OTH-
ER
E.L. EACH ACCIDENT
$1,000,000
0
E.L. DISEASE -POLICY LIMIT
$1,000,000
_
E.L. DISEASE -EA EMPLOYEE $1,000,000
OTHER
Y
DESCRIPTION OF OPERATIONSJLOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
RE: Pipe Bursting Project
City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Purchasing Division DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
215 N . Mason street
BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY
Fort Collins Co SOS22 USA OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
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AUTHORIZED REPRESENTATIVE CL �4��y6 L