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HomeMy WebLinkAbout110001 HIGH PLAINS MECHANICAL SERVICE INC - INSURANCE CERTIFICATEFrom:Morgan Fugate FaxID:(970) 484-4165 Page 1 of 2 Date:3/26/2013 10:02 AM Page:1 of 2 HIGH-13 OP ID: FM ,4�o�Ro CERTIFICATE OF LIABILITY INSURANCE DATDVVVV) 03126 03/26/13 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: 970482-7747 CONTACT NAME Brown & Brown Inc Fax: 970484-4165 4532 Boardwalk Dr, Suite 200 Fort Collins, CO 80525 Tyler B. Allen PHONE FAX A/C No Ext : (A/C, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Westfield Insurance Company 24112 INSURED High Plains Mechanical Service INSURERB: Pinnacol Assurance Company 41190 Inc. 2020 Airway Avenue INSURER C Ft. Collins, CO 80524 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. NOTVVITHSTAN DING 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 rypE OF INSURANCE ADDL INSR SUBIR NND POLICY NUMBER POLICY EFF MMIDD/YVVV POLICY EXP MMIDD/YVVV LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X TRA7477997 04/01/13 04/01/14 DAMAGE TO RENTED PREMISES Ea occurrence $ 500,000 CLAIMS-MADE� OCCUR MED EXP (Any one person) $ 15,000 PERSONAL & ADS INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OPAGO $ 2,000,000 POLICY X PECROT LOC J $ AUTOMOBILE LIABILITY COMBINED S INGLE LIMIT (Ed acadent $ 1,DDD,DDD X BODILY INJURY (Per person) $ A ANY AUTO TRA7477997 04/01/13 04/01/14 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED ITIFEDAUTO S AUTOS PROPERTY DAMAGE Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 A EXCESS LIAB CLAIMS -MADE TRA7477997 04/01/13 04/01/14 DED X RETENTION$ 0 $ B WORKERS COMPENSATION ANDEMPLOVERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 4052379 04/01/13 04/01/14 X WCSTAT U- OTH- TWOLIMITS ER E.L EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A E. L. DISEASE - EA EMPLOYEE $ 500,000 If yes describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ SOQ,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Fax: 221-6707 Attn: Christine See page 2 CERTIFICATE HOLDER CANCELLATION CITYFTC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of Fort Collins 281 N College Avenue Fort Collins, CO 80522 AUTHORIZE REPRESENTATIVE Tyler B. Allen Allen ACORD 25 (2010105) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD From:Morgan Fugate FaxID:(970) 484-4165 Page 2 of 2 Date:3/26/2013 10:02 AM Page:2 of 2