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HomeMy WebLinkAbout126722 WIRELESS CONSTRUCTION SERVICES - INSURANCE CERTIFICATE�Ro® CERTIFICATE OF LIABILITY INSURANCE OP ID MX DarE(MMmo/1 04 16 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: Mile Hi Insurance, Inc. LNE C, No, Est: (MC, No): ADDRESS: 4251 Xipling St. #220 Wheatridge CO 80033 IKUUMLLK CUSTOMERIDN: WIREL-1 Phone:303-237-5445 Fax:303-239-8807 INSURERS) AFFORDING COVERAGE NAICN INSURED INSURER A: Allied 19100 ��J Wireless Construction Services 0 Corrpporation 28051 Camel Heights Circle Evergreen CO 80439 INSURER B: P1nnaC01 41190 INSURER C: Zurich Insurance Co 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. IN5R LTR TYPE OF INSURANCE INSR Me POLICY NUMBER -PO" (MMIOOIYYYY) (MWDDIYYYY) LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X BLXT. ADDIL. INS. ACPGL07512652701 05/09/12 05/09/13 EACH OCCURRENCE s 1,000,000 PREMISESEa occurrence) $100,000 MED EXP(My one person) s5,000 PERSONAL$ ADV INJURY $1,000,000 X BLXT Waiver of Su GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: O. POLICY X PRO- LOC PRODUCTS - COMPIOP ADD $2,000,000 $ A AUTOMOBILE LIABILITY AUTO ALLOWNEDAUTOS SCHEDULED AUTOS AUTOS NON-0WNED AUTOS Blanket Add Insur ACPBA7512652701 05/09/12 05/09/13 COMBINED SINGLE LIMIT (Ea accident) $11000,000 ODILYINJUANY BRV(Perperson) $ BODILY INJURY(Per accitlent) $ IX PROPERTY DAMAGEHIRED (Per accident)$ $ $ A X UMBRELLA LJAB EXCESS UAB X OCCUR CLAIMS -MADE ACPCAA712652701 05/09/12 05/09/13 EACH OCCURRENCE $ 6, 000, 000 AGGREGATE $ 6,000,000 HDEDUCTIBLE X RETENTION $ 10,000 $ $ B C WORRER5 COMPENSATION AND EMPLOYERS' IIABILT' ANY PROPRIETORIPARTNER/ ECUTI YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes. descriee under DESCRIPTION OF OPERATIONS WIM N I A 50 15 WC969185801 OS /O1/12 05/01/12 OS/O1/13 05/01/13 X " TORV LIMITS ER E.L. EACH ACCIOENT $ 1, 000, 000 E.L. DISEASE - EA EMPLOYEE $ 1, 0 0 0 , 000 E.L. DISEASE -POLICY LIMIT 1 $ 1 , 000, 000 A InstallationEFloat quipm ACPCIM7522652701 05/09/12 05/09/13 SSPPRECCIAL $100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101. Additional Remarks Schedule, N more space Is recoiled) V CRIIfIVNIC nVLVCR I AAIULLLAIIUN CITY OF FORT COLLINS PO BOX 580 FORT COLLINS CO 80524 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 Michael Sean Xalen ©1988.2009 ACORD ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD