HomeMy WebLinkAboutMECHANICAL SOLUTIONS SIMPSON - INSURANCE CERTIFICATEACDRD,. CERTIFICATE OF LIABILITY INSURANCE o;;os,o9°"'
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Van Gilder Insurance Corp. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
700 Broadway, Suite 1000 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Denver, CO 80203
303 837-8500 INSURERS AFFORDING COVERAGE
INSURED INSURER Travelers Indemnity Company
Mechanical Solutions, LLC INSURER B: Pinnacol Assurance
dba Simpson Company
INSURER c
321 Basher Drive _..
INSURER D
Berthoud, CO 80513
' INSURER E:
,:UVtrI
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 POLICY EXPIRATION
DATE IMMIDDMI DATE MMIDD/YY
LIMITS
A GENERAL LIABILITY ',DTC00940N235COF09 01/01/09 ',01/01/10
EACH OCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABILITY
FIRE DAMAGE (Any one fire) $300,000
CLAIMS MADE X';, OCCUR',.
MED EXP(Any one person). $10,000
X PD Ded:2,500 Stop Gap WY Limits
PERSONAL &ADV INJURY $1,000,000
X .Stop Gap Llab Each Accident 1,000,000
GENERAL AGGREGATE $2,000,000
GENL AGGREGATE LIM ITAPPLIES PER Policy Limit j1,000,000 ',,
PRODUCTS COMPIOPAGG s2,000,000
POLICY X �E° ''.. LOC ( Each Employee 1,000,000
A AUTOMOBILE LIABILITY DT8100940N235TIL09 01/01/09 '01/01110
X
COMBINED SINGLE LIMIT
(Ea accident) $1,000,000
! ANY AUTO
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS .,
(Per person) $
X HIREDAUTOS
__..
BODILY INJURY
'. X '. NON -OWNED AUTOS ', ',
(Per accident) $
PROPERTY DAMAGE '.,. $
L (Per accident)
GARAGE LIABILITY -
AUTO ONLY - EA ACCIDENT '.$
ANY AUTO
OTHER THAN EA ACC $
AUTO ONLY: AGO $
A EXCESS LIABILITY DTSMCUP0940N235TIL 01/01/09 01/01/10
EACH OCCURRENCE $3,000000_
X OCCUR '.CLAIMS MADE
_
AGGREGATE $3,000,000
..,,DEDUCTIBLE
__... _.. ...._
,
...
__.. $ ._.
X''. RETENTION $10000
$
B WORKERS COMPENSATION AND 14038416 01/01/09 01/01/10
X WC STATU OTH
TORY,LIMITS
-. EMPLOVERS'LIABILITV ICOIOfadO OnlyI.
_ER
EL EACH ACCIDENT $1,000,000
',.
E.L. DISEASE - EA EMPLOYEE $1,000,000
E.L. DISEASE � POLICY LIMIT $1,000,000
A OTHER InlandMarine QT6600954N215 01/01/09 01/01/10
375,000 Inst Fltr Limit
$30,000 Leased)
300,000 Temp Storage
Rented Equip $1,000 Ded
100,000 Transit
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
RE: All Operations/ All Locations
If required by written contract or written agreement, City of Fort Collins is included as Additional
Insured for ongoing
operations under General Liability with respect to the above referenced. *Except 10 days notice for non-payment of premium.
SHOULD ANYOFTH EABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Fort Collins DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL*30 DAVSWRITTEN
PO Box 580 NOTICETOTHE CERTIFICATE HOLDERNAMED TOTHE LEFT, SUTFAILURE TODOSOSHALL
Fort Collins, CO 80522 IM POSE NO OBLIGATION OR LIABILITY OF ANYKIND UPON TH E INSURER,ITS AGENTS OR
AIJ-TH"ORIIZE' D"REPRI
AcotzD 10-S (7197)1 of 2 #M557096 KILT 0 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.
AGUKU Z5-5(0902 Ot 2 #M557096