HomeMy WebLinkAbout340571 MAX FIRE APPARATUS INC - INSURANCE CERTIFICATE (5)MAXFI-1 OP ID: VB
CERTIFICATE OF LIABILITY INSURANCE
D0112112014ATE Y,
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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
CRS Insurance Brokerage
Risk Solutions DBA
NAME: Sherry A. McGann
APHoloEt:303-996-7801Commercial
AIC 303757-7719
EMAIL
ADDRESS:
6600 E. Hampden Ave.
Denver, CO 80224
Sherry A. McGann
INSURERS) AFFORDING COVERAGE NAIC 1
INSURER A: Hartford Insurance Company 22357
INSURED Max Fire Apparatus, Inc.
Max Fire Apparatus, LLC �5 I
P.O. Box 1658
INSURERS: Pinnacol Assurance
INSURER C:
INSURER D:
Castle Rock, CO 80104
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.
LLTR
TYPE OF INSURANCE
14SR
POLICY NUMBER
MMIDONYW MMIDDIYYYY
LIMITS
A
GENERAL LIABILITY
X COMNERCIALGENERAL LIABILITY
CLAIMS.MADE O OCCUR
X
34UUN008093
11/07/2013 11/01/2014
EACH CCCURRENCE
$ 1,000,00
CAMAGE TO RENTED
PREMISES Eaoccunence
$ 300,00
MED EXP (Any one psrsm)
$ 10,00
PERSONAL & ADV INJURY
$ 1,000,00
GENERAL .AGGREGATE
$ 2,001
GEN'L AGGREGATE _IMIT APPLIES PER.
X POLICY PRO LOC
PRODUCTS- COMPIOP AGG
$ 2,000,00
$.
A
AUTOMOBILE LIABILITY
X ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
X HIP EC AUTOS N AUTOS
34UUN008093
11/01/2013 11/01/2014
c o tv BiTj —Ef SIVGLE _IMIT
Ea accident
$ 1,000,00
@ODILY INJUPY(Pe(person)
$
BODILY INJURY (Per ac:Itlenr)
$
PROPERTY DAMAGE
PER ACCIDENT
$
A
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
34HH0008094
11/01/2013 11101/2014
EACH CCCURRENCE
$ 1,000,00
AGGREGATE
$ 1,000,00
DED X I RETENTION$ 10000
$
B
WOPo(ERSCOMPENSA71ON
EMPLOYERS' LIABILITY Y 1 N
ANY PROPRIETOPJPARTNERIEXECUTIVE
OFFICER/MEMBER EXCLUDED'
(Mandatory in NH) Y
ir,es, dtb Lnbe wider
DESCRIPTION OF OPERATIONS below
NIA
077375
02/01/2014 02/01/2015
X WCS AT I OER
�61
E.L EACH ACCICENT
$ 100,00
E.L DISEASE. EA EMPLOYEE
$ 100,00
E.L DISEASE POLICY LIMIT
I $ 500,00
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space IsreRuired)
e: 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.
l policy terms, conditions and exclusions apply.
■ii Pl al -a 4A
CIFORTC
City of Fort Collins
P.O. Box 580
Fort Collins, CO 80522
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
*0y)
OO 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD