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HomeMy WebLinkAbout466684 MCLEMORE BUILD - INSURANCE CERTIFICATER CERTIFICATE OF LIABILITY INSURANCE FDATE (MMIDDIYVYV) 12 2g PRODUCER John L. Wortham & Son, L.P. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 2727 Allen Parkway ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE y HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Houston, TX 77019 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 713-526-3366 INSURED McLemore Building Maintenance, Inc. 110 Fargo Houston TX 77006 CnVFRA(ZFS INSURERS AFFORDING COVERAGE NAIC # INSURER A: Hartford Underwriters Insurance Company 30104 INSURER B: Hartford Insurance Co. of Midwest 37478 INSURER C: INSURER D: Argonaut Insurance Company 19801 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 ADD'L POLICY EFFECTIVE POLICY EXPIRATION OF INSURANCE POLICY NUMBER LIMITS A -TYPE GENERAL LIABILITY 61UUNAG4992 7/1/2009 7/1/2010 1 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGES ( RENTED PREMISES Ea occurrence) $ 300,000 CLAIMS MADE FVI OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY `/ jEC0j `/ LOC B AUTOMOBILE LIABILITY 61UUNAG4992 7/1/2009 7/1/2010 COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) 1,000,000 BODILY INJURY $ ALL OWNED AUTOS SCHEDULED AUTOS (Per person) BODILY INJURY $ HIRED AUTOS NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ D WORKERS COMPENSATION 47732826813 7/1/2009 7/1/2010 �/ WC sTATu- OTH- ER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N E.L. DISEASE - EA EMPLOYE $ 1 00Q 000 (Mandatory in NH) If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1 ()l)0 D00 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS See attached addendum. 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 DAYS WRITTEN PO Box 580 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Fort Collins CO 80522 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE John L. Wortham & Son, L J{/ , WPA649 4.10d ACORD 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. CERT NO.: 6542940 CLIENT CODE: 10MCLEMBUI (HOU) Linda Brown 12/28/2009 6:01:53 AM Page 1 of 3 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. CANCELLATION NOTICE The CANCELLATION NOTICE on the CERTIFICATE OF INSURANCE is amended to include the following wording: The Insurance Companies may cancel the described policy(ies) by mailing or delivering ten (10) days written notice of cancellation to the Named Insured for: (1) Non Payment of premium of (2) any other circumstance permitted by state law or policy conditions. ADDITIONAL INSURED DISCLAIMER Coverage for Additional Insureds can vary significantly from policy to policy and thus Additional Insured status does not guarantee protection for all losses. Coverage is subject to actual policy terms and conditions. CERT NO- 6542940 CLIENT CODE: 10MCLEMBUI (HOU) Linda Brown 12/28/2009 6:01:53 AM Page 2 of 3 Insured: McLemore Building Maintenance, Inc. 110 Fargo Houston TX 77006 Certificate Holder: Issue Date: 12/28/2009 City of Fort Collins PO Box 580 Fort Collins CO 80522 APPROVED WORDING FOR MCLEMORE BUILDING MAINTENACE EFFECTIVE: 07-01-2009 TO 07-01-2010 GENERAL LIABILITY AND AUTOMOBILE ADDITIONAL INSURED: City of Fort Collins, its Officers, Agents and Employees are included as an Additional Insured on all Policies when required by written contract as respects liability arising out of the Named Insured's work for the Additional Insured. . �A .,tu �.,, . �E tea" ..�. "t h ,5r„ M1':,. a.e• CERT NO.: 6542940 CLIENT CODE: 10MCLEMBUI (HOU) Linda Brown 12/28/2009 6:01:53 AM Page 3 of 3