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Home My WebLink About340571 MAX FIRE APPARATUS INC - INSURANCE CERTIFICATE (4)MAXFI-1 OP ID: SEA AFRO' CERTIFICATE OF LIABILITY INSURANCE DAT01/02D/YYYV) F 01/02/13 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 CONTACT NAME:- PHONE FAX A/C No Eat: AIC No: 6600 E. Hampden Ave. Denver, CO 80224 EMAIL ADDRESS: Sherry A. McGann -�1, I IYI.M' INSURERS AFFORDING COVERAGE NAICN INSURERA: Hartford Insurance Company 22357 INSURED Max Fire Apparatus, Inc. INSURER B: PInnacol Assurance Max Fire Apparatus, LLC. P.O. Box 1658 INSURER C: Castle Rock, CO 80104 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. INSR LTR TYPE OF INSURANCE A DL 9 POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY UP MMIDDIYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR X 34UUNQ08093 11/01/12 11/01/13 EACH OCCURRENCE $ 1,000,00 PREMISES JEa occurrence $ 300,00 ME UP (Any one person) $ 10,00 PERSONAL S ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GENL AGGREGATE LIMIT APPLIES PER: X POLICY PRO- LOC PRODUCTS - COMPIOP AGO $ 2,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS 34UUN008093 11/01/12 11/01/13 COMBINED SINGLE LIMIT Ea accident $ 1,000,00 X BODILY INJURY (Par parson) $ BODILY INJURY (Per accident)$ X PROPERTY DAMAGE Per accident $ $ A X UMBRELLA LIAR EXCESS ME X OCCUR CLAIMS -MADE 34HH0008094 11/01/12 11/01/13 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 DED X RETENTION 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITYQR ANY PROPRIETOR/PARTNER/EXECUTIVEYIN OFFICERIMEMBER EXCLUDED? I y I (Mandatory in NH) If yes, tlasu los under DESCRIPTION OF OPERATIONS below NIA 4077375 02/01/13 02/01/14 X WCSTATUIM - OTH- E.L. EACH ACCIDENT $ 100,00 E.L. DISEASE - FA EMPLOYEE $ 100,00 E.L. DISEASE -POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional 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 �REPRESENTATIVE ACORD 25 (2010/05) V T9tlti-2U70 ACOHU CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD