HomeMy WebLinkAboutCORRESPONDENCE - GENERAL CORRESPONDENCE - INSURANCEACORD CERTIFICATE OF LIABILITY INSURANCE OP ID J3 DATE(MM/DD/YYYY)
MMPAC-1 06 17 09
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Rich 6 Cartmill Ins of CO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
of Colorado LLC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
8213 W. 20th Street
Greeley CO 80634
Phone:970-356-8030 Fax:970-356-8032
INSURED
MM Packagin Products, Inc
dba MM Soluions and
MM Packaging, Inc.
3321 N. Garfield Ave
Loveland CO 80538
INSURERS AFFORDING COVERAGE NAIC #
INSURER A: St Paul Travelers 40282
INSURER B: Plnnacol Assurance
INSURER C:
INSURER D:
INSURER E:
tUVERAGES
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
DATIEYMM/FDDIYYE
PDATEY MM DD/YY EXPIVATI—ON
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
PREMISES(Eaoccurence)
$ 100,000
A
X COMMERCIAL GENERAL LIABILITY
660-435OM507-IND-08
06/18/09
06/01/10
MED EXP (Any one person)
$ 5,000
CLAIMS MADE X❑ OCCUR
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 2 , 000 , 00O
POLICY PROJECT LOC
A
AUTOMOBILE
LIABILITY
ANY AUTO
BA3115L54A-08
06/18/09
06/01/10
COMBINED SINGLE LIMIT
(Ea accident)
$ 1000000
X
BODILY INJURY
-(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
BODILY INJURY _._ .
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
'
X
PROPERTY.DAMAGE
(Per accident)
$
'- --
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$ 6000000
AGGREGATE
$ 6000000
A
X OCCUR CLAIMSMADE
CUP-6803Y569-IND-08
06/18/09
06/01/10
$
DEDUCTIBLE
$
X RETENTION $ 5000
WORKERS COMPENSATION AND
TORY LIMITS ER
E.L. EACH ACCIDENT
$ 100000
B
EMPLOYERS' LIABILITY
ANY'PRCiPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
3443901
06/01/-0.9.
06/01/10
E. L, DISEASE - EA EMPLOYEE
$ 100000
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
$ 500000
OTHER
A
Property
660-435OM507-IND-08
06/18/09
06/01/10
Blk Limit $393,750
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
rFRTIFICATF HOLDER t.AlVlrtLLA I IVIV
City of Fort Collins
Purchasing Divsion
John Phelan
PO Box 580
Fort Collins CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 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 INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Shawn A Wotowey
ACORD 25 (2001/08) v At.vrcv %1Vrcrvr%A 1 Ivry 1700
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.
ACORD 25 (2001/08)