HomeMy WebLinkAbout340571 MAX FIRE APPARATUS INC - INSURANCE CERTIFICATE (2)MAXFI-1 OP ID: VB
AFRO' CERTIFICATE OF LIABILITY INSURANCE
OAT1013111 YYY)
10/31/12
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 endorsements .
PRODUCER Phone:303-996-7801
CRS Insurance Brokerage Fax: 303-757-7719
Commercial Risk Solutions DBA
6600 E. Hampden Ave.
Denver, CO 80224
CONTACT
PHONE.. FA%
A/C NExit: ac No:
E-MAIL
ADDRESS:
Sherry A. McGann '1 f �
INSURERS AFFORDING COVERAGE
NAIC e
INSURER A: Hartford Insurance Company
22357
INSURED Max Fire Apparatus, Inc.
INSURER B: Plnnacol Assurance
Max Fire Apparatus, LLC.
P.O. Box 1658
INSURER C:
Castle Rock, CO 80104
INSURER D:
INSURER E
NSURER 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.
INSR
LTR
TYPEOFINSURANCE
A
SUBS
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
MDOL
W ICY EXP
DD/YYYY
UNITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
X
34UUNQ08093
11/01/12
11/01/13
EACH OCCURRENCE
$ 1,000,00
PREMISES Ea occurrence
$ 300,00
MED EXP (Any one person)
$ 10,00
PERSONAL S ADV INJURY
S 1,000,00
GENERAL AGGREGATE
$ 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER'.
X POLICY PRO LOC
PRODUCTS - COMP/OP AGO
E 2,000,00
$
A
AUTOMOBILE LJABIUTY
X ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
X HIRED AUTOS X NON -OWNED
AUTOS
34UUN008093
11/01/12
11/01/13
COMBINED SINGLE LIMIT
Ea accident
E 1,000,00
BODILY INJURY (Par person)
$
BODILY INJURY (Per accident)
E
PROPERTY DAMAGE
Per accident
$
A
X
UMBRELLALIAB
EXCESS LIAR
X
OCCUR
CLAIMS -MADE
34HHUQ08094
11/01/12
11/01/13
EACH OCCURRENCE
$ 1,000,00
AGGREGATE
$ 1,000,00
OED I X I RETENTION$ 10,000
1 $
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORMARTNER/EXECUTIVE YIN N
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
If Yea, desame under
DESCRIPTION OF OPERATIONS below
NIA
4077376
02/01/12
02101113
X WC STATU- OTH-
E.L. EACH ACCIDENT
$ 100,00
E.L. DISEASE -EA EMPLOYEE
$ 100,00
E.L. DISEASE -POLICY LIMIT
1 E 600,00
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Addidonal Remarks Schedule, If more space Is required)
Re: Fleet Maintenance. City of Fort Collins is included as additional
insured on the General Liability with respect to ongoing operations of the
named insured for the certificate holder as required by written contract.
All policy terms, conditions and exclusions apply.
City of Fort Collins
P.O. Box 580
Fort Collins, CO 80522
CIFORTC
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 REyPyR�ES,ENN/TAT�IVEE
ACORD 25 (2010106)
V 1988-ZU11) ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD