HomeMy WebLinkAboutH&M MECHANICAL LLC - INSURANCE CERTIFICATE'``l b?e CERTIFICATE OF LIABILITY INSURANCE
7/31/2014�)
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: N the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. U 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
CONTACT NAME: BrandiE Zuckerman, CRIS.
Moody Insurance Agency, Inc.
8055 EastPHONE Tufts Avenue
(303)824-6600 FNL No:(303)370-0118
E-MAIL .brandie.zuckerman@moodyins.com
Suite 1000
INSURERS AFFORDING COVERAGE
NAIC9
INSURERA:Union Insurance Co
25844
Denver CO 80237
INSURED
INSURER B:Pinnacol Assurance
41190
INSURER C:
B&M Mechanical, LLC
INSURER D:
108 E RIIm a Street
NSURER E
Lafayette CO 80026
INSURER,:
COVERAGES CERTIFICATE NUMBER:14-15 No Forma 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.
MISS
LTR
TYPE OF INSURANCE
ADDLSUBR
I=POLICY
NUMBER
POLICY EFF
MMDNYYY
POLICY EXP
M /YYYY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
E 11000,000
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE ❑X OCCUR
PA3068937-21
/1/2014
8/1/2015
DAMAGE( RENTED
PREMISESSEa occurrence)
E 11000, 000
MED EXP (My one person)
E 10,000
PERSONAL B ADV INJURY
E 11000,000
GENERAL AGGREGATE
$ 2,000,000
GEWL AGGREGATE
LIMIT APPLIES PER
PRODUCTS - COMP/OP AGG
9 2,000,000
X1 POLICY
'PRO LOG
E
AUTOMOBILE
LIASILDY
COMBIBI tlEEDt SINGLE LIMIT
1,000,000
=�
BODILY INJURY (Per person)
S
A
MY AUTO ...
ALL OWNED X SCHEDULED
AUTOS AUTOS -
PA3068937-21
/1/2014
8/1/2015
1C
BODILY INJURY
.. (Per accident)
E
HIRED AUTOS NON -OWNED
AUTOS
PROPERTY DAMAGE
Per accident'
S
E
X
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE
$ 3,000,000
AGGREGATE
S 3,000,000
A
EXCESS LIAB
CLAIMS MADE
DED I I RETENTIONg
-
$
PA3068937-21
8/1/2014
8/1/2015
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOWPARTNERIEXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
II es. describe under
N/A
4166620
/1/2019
/1/2015
X WC STATU- OTH-
I TOR LIMITS FR
E.L. EACH ACCIDENT
$ 500,000
E.L. DISEASE - EA EMPLOYE
$ $00 000
E.L. DISEASE - POLICY LIMIT
E $ GD 000
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Aflach ACORD 101, Additional Remarks Schedule, if more space is required)
Fort Collins
PO Box 580
Ft. Collins, CO
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
80522 I AUTHORIZED REPRESENTATIVE
ACORD
Zuckerman, CRIS/BRA
1988-2010 ACORD CORPORATION.
ursauzo (201005pol The ACORD name and logo are registered marks of ACORD