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Home My WebLink About165318 CMS MECHANICAL SERVICES INC - INSURANCE CERTIFICATE (2)'E�!Rb® CERTIFICATE OF LIABILITY INSURANCE OF ID DA DATE(MMDDYYYY) 05/14/12 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 NAME: Brown & Brown Inc 4532 Boardwalk Dr, Suite 200 PHONE FAX AIC, No, Esq: (AIC, No): ADDRESS: Certificates@bbcolorado.com Fort Collins CO 80525 -PRODUCER CUSTOMERID%: CMSME-1 Phone:970-482-7747 Fax:970-484-4165 INSURER(S) AFFORDING COVERAGE NAIC0 INSURED t 1 INSURER A: Westfield insurance Con,any 24112 CMS Mechanical Services, Ync. S 609 Technology Circle, uite A Windsor CO 80550 INSURER B: Pinnacol Assurance Company 41190 INSURER C: INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 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. ILTR TYPE OF INSURANCE ISRI BR WVDI POLICY NUMBER -POLICY (MOLIC YYYY) ( POLICYXP YVYY) LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS-MADElxl OCCUR TRA6047660 04/27/12 04/27/13 EACH OCCURRENCE DAMAGETPREMSESO(Ed occurrence) $ 1,000, 000 $ 300000 MED EXP(My cne person) $10,000 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE $ 2, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: X I POLICY F7 PROT LOC JEC PRODUCTS - COMP/OP AGG $2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS TRA6047660 04/27/12 04/27/13 COMBINED SINGLE LIMIT (Ea accident) $1, 000, 000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident $ $ $ A X UMBRELLA LIAB EXCESS LIAB $ OCCUR CLAIMS -MADE TRA6047660 04/27/12 04/27/13 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 X DEDUCTIBLE RETENTION $ 10,000 $ Is B Q.W.WRS LOMPE...To- ANDEMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVBI�I OFFICERIMEMBER EXCLUDED? a (Mandatory in NH) If yes, describe under OESC RIPTION OF OPERATIONS below IA 4105092 06/01/11 '06/01/12 X Y ATV- - TORY LIMITS ER E. L. EACH ACCIDENT $l, ODD, DDD EL.DISEASE- EA EMPLOYEE$ 1, 000, 000 E.L. DISEASE -POLICY LIMIT 1 $ I , 000, 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) See Notes CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITYFT5 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins AUTHORIZED REPRESENTATIVE Purchasing P. O. Box 580 ---'-- \ / reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD lIf CMD DA DATE OS/14/12 PAGE 2 NOTEPAD.INSURED'SNAME CMS Mechanical Services, Inc. OP ID required by written contract, the following blanket endorsements apply: CG3227 (6/10)-Colorado Additional Insured -Owners, Lessees or Contractors -Ongoing Operations CG3228 (6/10)-Colorado Additional Insured -Owners, Lessees or Contractors -Completed Operations CG7055 (12/98)-Blanket Other Insurance Condition Amended (Primary/Noncontributory) CG7094 (08/05)-Contractors General Liability Expanded Plus Endorsement -Including Blanket Waiver of Subrogation Auto Liability: CA7078 (9/11)-Business Auto Expanded Endorsement -Including Blanket Additional Insured CA0444 (3/10)-Waiver of Transfer of Rights of Recovery Against Others CA7075 (10/08)-Primary and Noncontributory Insurance Endorsement Workers Compensation: 359B - Blanket Waiver of Subrogation IN OTEPAD.. HOLDER CODE CITYFT5 CMSME-1 PAGE.3 INSURED'SNAME CMS Mechanical Services, Inc. OP ID DA DATE 05/14/12 The City of Fort Collins, its officers, agents and employees shall be named as additional insured" on the general liability & automobile insurance. OK7 . CERTIFICATE OF LIABILITY INSURANCE OPID JD DATE(MMIDDYYYY) 4 27 12 0412 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 NAME: PHONE AIC, No, Ezt : (A/C, No): Brown & Brown Inc Certificates@bbcolorado.com 4532 Boardwalk Dr, Suite 200 Fort Collins CO 8052$ _ADDRESS: PRODUCER CUSTOMER 10 p: CMSME-1 Phone:970-482-7747 Fax:970-484-416$ INSURER(S) AFFORDING COVERAGE NAICN INSURED INSURER A: Westfield insurance company 24112 CMS Mechanical Services, Inc. 609 Technology Circle, Suite A Windsor CO 80550 INSURER B: Pinnacol Assurance Company 41190 INSURER C: INSURER 0 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 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. LTR TYPE OF INSURANCE INSR MD POLICY NUMBER (MMIDD/YYYY) (MMIDD/YYYY) LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR TRA6047660 04/27/12 04/27/13 EACH OCCURRENCE PAWS G O(Ea occurrence) $1, 000, 000 S300000 MED EXP(Any one person) 510,000 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n PRI- JECT LOC PRODUCTS - COMP/OP AGG $2,000,000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS TRA6047660 04/27/12 04/27/13 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Par person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ A X UMBRELLA LIAB EXCESS LIAB IX OCCUR CLAIMS -MADE TRA6047660 04/27/12 04/27/13 EACH OCCURRENCE $2, QQQ,00Q AGGREGATE $2,000,000 DEDUCTIBLE RETENTION $ 10,000 S X $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNER/EXECUTIVG� OFFICER/MEMBER EXCLUDED? a (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 4105092 06/Ol/11 TORY LIMITS ER EL EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITYFT$ I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins Purchasing 281 N College Avenue ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD 'S NAME If required by written contract, the following blanket endorsements apply: General Liability: CG3227 (6/10)-Colorado Additional Insured -Owners, Lessees or Contractors -Ongoing Operations CG3228 (6/10)-Colorado Additional Insured -Owners, Lessees or Contractors -Completed Operations CG7055 (12/98)-Blanket Other Insurance Condition Amended (Primary/Noncontributory) CG7094 (08/05)-Contractors General Liability Expanded Plus Endorsement -Including Blanket Waiver of Subrogation Auto Liability: CA7078 (9/11)-Business Auto Expanded Endorsement -Including Blanket Additional Insured CA0444 (3/10)-Waiver of Transfer of Rights of Recovery Against Others CA7075 (10/08)-Primary and Noncontributory Insurance Endorsement Workers Compensation: 359B - Blanket Waiver of Subrogation