HomeMy WebLinkAboutMCKUSKER ELECTRIC INC - INSURANCE CERTIFICATEACORDM CERTIFICATE OF LIABILITY INSURANCE
DATElz/23/D/ola2014)
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
4025 St. Cloud Dr.
Suite 100
Loveland, CO 80538
CONTACT
NAME: Dustin Sadowski
aX,Ne; 866.4S6.4265
BsE:,,d;97t0i.679.7375
usn-sadowski@leavitt.com
INSURER(S) AFFORDING COVERAGE
NAIC#
INSURER A: American States Insurance Co
019704
INSURED MCKUSKER ELECTRIC, INC.
115 HUNTERS COVE RD
MEAD, CO 8OS42
INSURERB: Pinnacol Assurance
41190
INSURER C:
INSURERD:
INSURER E :
INSURER F
COVERAGES CERTIFICATE NUMBER: 15-16 WC 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.
LT R
TYPE OF INSURANCE
INSR
WVD
POLICY NUMBER
MMMD/YYYY
MMIDDM'YY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE ❑X OCCUR
X Blkt Add't Insd
01CI608922-30711112014
ADDITIONAL INSRD FOR
ONGOING OPERATION
07/11/2015
EACHOCCURRENCE
$ 1,000,00
-DAUINGRENTEU-
PREMISES Ea
$ 200,00
MED EXP (Any one person)
$ 10,00
PERSONAL B ADV INJURY
$ 1,000,00
GENERAL AGGREGATE
$ 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY P"OJECT LOC
PRODUCTS-COMP/OP AGG
$ 2,000,00
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALLOWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIREDAUTOS AUTOS
Ea accitlenl
$
BODILY INJURY IPer person)
$
BODILY INJURY (Pereccitleni)
$
Per accitlenl
$
$
A
UMBRELLA UAB
EXCESS LAB
X
OCCUR
CLAIMS -MADE
01XS161042-SC
07/11/2014
07/11/20151
EACH OCCURRENCE
$ 1,000,00
X
I AGGREGATE
$ 1,000,00
DIED I I RETENTION$
1
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUDED ANY ECUTIVfI`-11 T�
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS be.
MIA
337544201/0112015
01/0112016
X TORV LIMITS ER
E.L. EACH ACCIDENTOOO,
00
E.L. DISEASE - EA EMPLOYEE
$ 1 , 000, OO
E.L. DISEASE -POLICY LIMIT
$ 1, OOO, 000
A
Contractors Equipment
01CI608922-307/11/2014
07/11/2015
Installation Floater $50,000
$1,000 Ded
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
City of Fort Collins
281 N. College Ave.
Fort Collins, CO 80S24
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 /1 J7 ,-40
All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD