HomeMy WebLinkAbout450906 MULLER ENGINEERING CO INC - INSURANCE CERTIFICATEOP ID: BH
14t4Coizo CERTIFICATE OF LIABILITY INSURANCE
DAT09/05D/YYYV)
F 09/05112
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 endorsements .
PRODUCER 800-338-1391
SH
701 Market St., Ste. 1100 888-621-3173
St. Louis, MO 63101
CONTACT
NAME:
FAX
aac No:
E-MAIL
ADDRESS:
PRODUCER MULLE-1
CU TOM ER ID e:
INSURERIS) AFFORDING COVERAGE
NAIC N
INSURED Muller Engineering Co., Inc.
INSURER A: Hartford Accident & Indemnily
777 S.Wadsworth Blvd., Ste 100
Lakewood, CO 80226
INSURER B:
INSURER C
INSURER D :
INSURER E:
INSURER F :
COVERAGES CERTIFICATE NUMBER: RFVISIONNUMRFR-
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
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MM/DDNYYY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 2,000,00
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE O OCCUR
84SBWCT1553
11/01/12
11101113
PREMISES Eaoccurrence
$ 2,000,00
MED EXP (Any one person)
$ 10,00
PERSONAL E ADV INJURY
$ 2,000,00
X XCU
GENERA -AGGREGATE
$ 4,000,00
PROFESSIONAL LUIB EXCL
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGO
$ 4,000,00
POLICY X PRO LOC
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
84UEGNS8431
11101112
11/01/13
COMBINED SINGLE LIMIT
Ea accident)
$ 2,000,00
X
BODILY INJURY
BODILY NJURY (Per person)
E
ALL OWNED AUTOS
_
BODILY INJURY (Per ecciden)
E
SCHEDULED AUTOS
HIRED AUTOS
X
PROPERTY DAMAGE
(Per accident)
$
X
$
NON -OWNED AUTOS
8
UMBRELLA UAB X
OCCUR
EACH OCCURRENCE
$ 1,000,00
AGGREGATE
S 1,000,00
A
EXCESS LIAR
CLAIMS -MADE
84SBWCT1553
11/01/12
11I01113
DEDUCTIBLE
E
$
RETENTION S
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITYrLIM
ANY PROPRIETORPARTNEREXECUTIVE YIN
OFFICER/MEMBER EXCLUDED? ❑
N/A
84WEGPM0143
11/01/12
11/01/13
X WC STATU- OTH-
EL EACH ACCIDENT
$ 1,000,00
EL. DISEASE - EA EMPLOYEE
$ 1,000,00
(Mandatory In NH)
If yes do scribe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
S 1,000,00
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, d more space Is required)
RE: P1147 SIGNAL TIMING PROGRAM. THE CITY, ITS OFFICERS AND EMPLOYEES IN
ACCORDANCE WITH COLORADO LAW ARE INCLUDED AS ADDITIONAL INSURED FOR ABOVE
COVERAGES EXCEPT W/C.
CTYFTCO
CITY OF FT. COLLINS
ATTN: JAMES B. O'NEILL
PO BOX 580
FT. COLLINS, CO 80522-0580
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 CORPORATION All rinhfe reeers,ea
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD