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HomeMy WebLinkAbout406748 MCMS INC - INSURANCE CERTIFICATECERTIFICATE OF LIABILITY INSURANCE DATEo1/2s/zolz5/2I012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER Ewing -Leavitt Insurance Agency CONTACT Karole Peters NAME: a. NOE,t;970.679.7355 aDNq:866.237.2178 AIL ADDRESS: karole-peters@leavitt.com 4025 St. Cloud Dr. PRODUCER 00002572 CUSTOMER ID N: Suite 100 INSURER(S) AFFORDING COVERAGE NAICN Loveland, CO 80538 INSURED INSURER A: Cincinnati Insurance Co INSURER : Pinnacol Assurance 41190 MCMS, Inc. 136 Bothun Rd INSURER C: Berthoud, CO 8OS13 INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 11-12 w WC update REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ] OCCUR X Blkt Addl Insured CPPI073982:06125/2011 06/25/2012 EACH OCCURRENCE $ 1,000,00 DAMAGE SE TO a RENTED ence $ 500, 00 MED EXP (Any one person) $ 10,000 PERSONAL BADVINJURY $ 1,000,00 X Blkt Waiver of Sub GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC ECT PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNEDAUTOS CPP107398206/25/2011 06/25/2012 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ $ A X UMBRELLA LIAB EXCESS UAB X OCCUR CLAIMS -MADE CPP107398206/2512011 06/25/2012 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DEDUCTIBLE RETENTION $ $ X $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N OFFICERIMEM ER EXCLUDED? ANY PROPIRIETORIPARTNEWEECUTIVE ] (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 4089148 02/01/2012 02/01/2013 X TORY LIMIL OETH R E.L. EACH ACCIDENT S SOD, OO E. L. DISEASE - EA EMPLOYEE $ 500, 00 E.L. DISEASE -POLICY LIMIT $ 500,00 A Leased and Rented Equipment CPP1073982i 06/25/2011 1$5,000 06/25/2012 $200,000 limit deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION FAX: 970.221.6378 City of Fort Collins PO Box 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988.2009 ACORD ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD