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HomeMy WebLinkAbout406748 MCMS INC - INSURANCE CERTIFICATE (3)ACORD CERTIFICATE OF LIABILITY INSURANCE H DATE(MM/DD/YYYY) 06/10/2014 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 endorsement(s). PRODUCER Ewing -Leavitt Insurance Agency 402S St. Cloud Dr. Suite 100 Loveland, CO 80538 ol CONTACT NAME: Karole Peters Pa"c°Nm E.e:970.679.7355FAX NC,Ne;866.237.2178 ADDRess: karole-peters@leavitt.com INSURER(S) AFFORDING COVERAGE NAIC If INSURER A: Cincinnati Insurance Co 10677 INSURED MCMS, Inc. 136 Bothun Road Berthoud, CO 80513 INSURER : Plnnacol Assurance 41190 INSURER C: INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 14-15 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. LTR TYPE OF INSURANCE INSR WVD POLICYNUMBER MMIDDIYYYY MM/DDNYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X Blkt Addl Insured EPP0146955 06/25/2014 06125/2015 EACH OCCURRENCE $ 1,000,000 PREMISES JEa occurrence $ 500,00 MED EXP (Any one person) $ 10,00 PERSONAL S ADV INJURY $ 1,000,00 X Blkt Waiver of Sub GENERAL AGGREGATE $ 2,000,00 GENL AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC ECT PRODUCTS-COMP/OP AGO $ 2,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS EPP014695506/25/2014 06/25/2015 (Ea accident) $ 1,000, 00 X BODILY INJURY (Per person) $ BODILY INJURY ( Per arsAtleni ) $ X Per accident $ A Jt UMBRELLA UAB EXCESS LIAB X OCCUR CLAIMS -MADE EPP014695S 0612512014 06/2512015 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 DED X RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTN OFFICER/MEMBER EXCLUDED? � (Mandatory In NH) If yyes, describe under DESCRIPTIONOFOPERATIONS below N /A 408914 02/01/2014 02/01/2015 X TORV LIMITS ER E.L. EACH ACCIDENT $ 50O 0O r E.L. DISEASE -EA EMPLOYE $ SDO, 00 - E.L. DISEASE -POLICY LIMIT I -- $ 500,00 A Inland Marine EPP014695506/25/2014 06/25/2015 Leased/Rented Equipment $730,000 limit w/ $5,000 ded DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION FAX: 970.221.6378 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 AUTHORIZED REPRESENTATIVE J PO Box 580 Fort Collins, CO 80522 Karole Peters KAPETE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD