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Home My WebLink About165318 CMS MECHANICAL SERVICES INC - INSURANCE CERTIFICATE (3)Rb® CERTIFICATE OF LIABILITY INSURANCE OP ID JD DATE (MMIDD Y2YYY) 05 4 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 PHONE FAX _rMCANO Ell): (MC. No): ADDRESS: CertificatesBbbcolorado.com 4532 Boardwalk Dr, Suite 200 Fort Collins CO 80525 PRODUCER CUSTOMER ID N: CMSME-1 Phone:970-482-7747 F1ax:970-484-4165 INSURER(S) AFFORDING COVERAGE NAICN INSURED 1lv> )`j INSURER A: Westfield Insurance company 24112 CMS Mechanical Services,uite A Inc. 609 Technology Circle, S INSURER B: Pinnacol Assurance Company 41190 INSURER C: Windsor CO 80550 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. INTRR TYPE OF INSURANCE NSR II ADDUSWVDI POLICY NUMBER MM% DNYYY'TPOLICY EXP LIMITS ( ) I(MMIDC YYYY) A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR TRA6047660 04/27/12 04/27/13 EACH OCCURRENCE $1,000,000 PREMSES(aoccurrence) $300000 MED EXP (Any one person) $ 10,000 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X 1 POLICY JPRO F LOC PRODUCTS -COMP/OP AGO $2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON -OWNED AUTOS TRA6047660 04/27/12 04/27/13 COMBINED SINGLE LIMIT (Ea accident) $1, OOQ, Q00 X BODILY INJURY (Per person) $ BODILY INJURY (Per accitlen0 $ PROPERTY DAMAGE (Per accident) $ $ $ p.' X UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE TRA6047660 04/27/12 04/27/13 EACH OCCURRENCE $2,000,000 AGGREGATE $ 2,000,000 DEDUCTIBLE RETENTION $ 10, 000 $ X s B WORKERS COMPENSATION ANDEMPLOYERS'LIABILITV YIN ANY PROPRIETORIPARTNERJEXECUTIVF>--I OFFOERIMEMBER EXCLUDED? u (Mandatory in NH) If es, describe under DESCRIPTION OF OPERATIONS below I NIA 4105092 06 /Ol/12 06/01/13 X ALL - TORY LIMITS ER E.L.EACH ACCIDENT $1, QQQ, QQQ EL DISEASE - EA EMPLOYEE$ 1, QOQ,Q00 E.L. DISEASE -POLICY LIMIT 1 $1, 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 City of Fort Purchasing P. O. Box 580 Fort Collins Collins CO 80521 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITYFTS I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. All riahfe'.—d ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD NOTEPAD. HOLDER CODE CITYFT5 CMSME-1 PAGE 3 INSURED'SNAME CMS Mechanical Services, Inc. OF ID JD DATE 05/24/12 The City of Fort Collins, its officers, agents and employees shall be named as additional insured on the general liability & automobile insurance.