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HomeMy WebLinkAboutNORCON OF NEW MEXICO LLC - INSURANCE CERTIFICATENORCO-1 OP ID: WM YYI CERTIFICATE OF LIABILITY INSURANCE D0212012014 ozrzorzola 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 endorsement(s). PRODUCER _NAME: ACT RO er Milbert Cress Insurance Consultants PHONE .505.822$114 N : 505-022-0341 6101 Moon St. NE Suite 1000 c No E Albuduercue. NM B7111 INSURED —? Norcon of New Mexico LLC INSURER B: 3700 Osur a Rd NE Ste 611 Albuquerque, NM 87109 INsuRERc: rnvrnnr_ce rCOTICIr ATc Mrl AeOCR- ROVIRInId ulIURCO- 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. MR LTR TYPE OF INSURANCEADVIL JUSE, POLICY NUMBER WO LIMITS GENERAL LMBIL" COMMERCIAL GENERAL LIABILITY CLAIMB-MADE ❑ OCCUR 1 CEN'L AGGREGATE LIMIT APPLIES PER' b LOC P%1CY 'IF EACH OCCURRENCE E PREMISES Es o00umeme i M£D ExP (Arty one pweon) t PERSONAL 8 ADV INJURY E GENERAL AGGREGATE E PRODUCTS. COMPICRAGO E E AUTOMOBILELMBILRY ANY AUTO SOS OWNED SCHEDLLED HIRED AUTOS AUTCS © LIMITINOUE O eccl eM BODILY INJURY (PW penonl E BODILY INJURY (Per emIdIct) Il ROPERTY DAIMAGE PER ACCIDENT E E UMBRELLA LIAR EtCESSUAB CLAIMSMLV7E EACH OCCURRENCE E AGGREGATE E DED �RETENt10N E A WORKERS COMPENSATION ANO EMPLOYERS' LMBILT' AWPRTIPRFTORIPAPTNIPFF Ff.I mVF Y/M IMi�MIMEXCLUDED' Np II yae, omodbe undw DESCRIPTION OF OPERATIONS WIM MIA 111 01/01I201a 01J01/2015 x WC STATLL OTH- EL EAf.YI ACCIDENT E 1,000,00 E.L., DISEASE - EA EMPLOYEE E 1,000.00 EL DISEASE - POLICY LIMIT I E 1,000,00 DESCRIPTION OF OPERATIONS 1 LOCATIONS; VEHICLES (Attech ACORD 101, Addhlonel Reme Rs Schedule. Ymore space Is required) Jo: Utilities Service Center, 700 Wood St, Fort Collins, CO 80522. Work Comp olicy includes-DSaE�9aiver of Subrogation, if required by written contract. MISCELI 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 PO Box 580 Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE cy TBaB-zuTu cYt.L�Hu L.vHPCIrcA IILIrv. All rlgnrs reserves. ACORD 25 (201=5) The ACORD name and logo are registered marks of ACORD New Mexico Assurance Company Workers' Compensation and Employers' Liability Policy WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule BLANKET WAIVER PER CONTRACT(S) ON FILE WITH EMPLOYER WORK LOCATION(S): NEW MEXICO AND WHILE TEMPORARILY WORKING OUTSIDE THE STATE OF NEW MEXICO Nothing in this endorsement contained shall be held to vary, alter, waive or extend any of the terms, conditions, agreements, or limitations of this policy other than as above stated. Nothing elsewhere in this policy shall be held to vary, alter, waive, or limit the terms, conditions, agreements or limitations of this endorsement. This endorsement when attached to Policy No. 30444.111 issued to NORCON OF NEW MEXICO LLC shall be valid and shall form part of said policy. The effective date of this endorsement is 01/01/2014 12:01 A.M. Mountain Standard Time. Endorsement No: Date Issued: 11/27/2013 THE FOLLOWING SPACES ARE TO BE COMPLETED ONLY IF THIS ENDORSEMENT IS NOT ATTACHED TO THE POLICY WHEN ISSUED Countersignature of Licensed Resident Agent WC 00 03 13