HomeMy WebLinkAboutLAKESIDE MECHANICAL SERVICE INC - INSURANCE CERTIFICATEACORq CERTIFICATE OF LIABILITY INSURANCE
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02/11/2015
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, subfectto
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 endomemengs).
PeoquceR
CONTACT Karole Peters
NAME:
Ewing -Leavitt Insurance Agency
4025 St. Cloud Dr.
PAID" E 970.679.7355 AIC Mn,866, 237.2173
Kim
karol e-petersOl eavitt.ccen
Suite 100
Loveland, CO SOS39
waUneg191AFFONgno cowuge
"Awe
N MRA: Secure Insurance
2ZS43
INSURED Lakeside Mechanical Service, Inc.
NUMBER e: Pilmacol Assurance
41190'
900 Engleman Place
INSURER C:
Loveland, CO 8OS38
INMIRERD:
INSURER E:
INSURER F:
CERTIFICATE NUMBER: 15-16
THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOWHAVE 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.
L1R
TYPE OF INSURANCE
MR
WVD
POLICY NUMBER
Mn10
MM
Canis
A
0E"ERAL LIABILITY
X COMMERCNL GENERY LIPBILRY
CAIMSMADE OOCCUR
X S1kt Addi Insured
TC318900
02/23/2015
0=312018
EACHOGCURRENGE
$ 1,000,00
PREMISES Eeasw
! 500,00
MEDEXP(Mymepron)
$ 5,00
PERSON&AADVINJURY
$ Include
X
Blkt Waiver of Sub
GENERALAGGREGATE
$ 2 000,0
GENLAGGREGAMUMITAPPLIESPER:
POLICY X J LOC
PRODUCTS-CAMPIOPAGG
A
AUTOMOBILE LMBILm
ANYAUTOBODILYINJURY(Psion
ALLOWNEO SCHEWLED
W NEDXHIRED AUTOS X AUTOSUMIRILLALIARXOCCUR
A31890
021=015
0212312018
E, some
)
DODILYIWURYIPxnUEFnqAUTOSAUTOSNON
j2,QDW0,0
A
EXCESSYA!
CLAIMSMADE
CU318900
02/2312015
02/2312016
EACH OCCURRENCE
AGGREGATE
DED X RE NM)Nf 10,
B
wRSCOMPEN"nm
AMID EMPLOYERS' LMBIUTYo YIN
MY PROPRIETORIPAR'MELF.%ECUT V
OFFICEWMEMBEREXCLUDEOT
(MRNAPPy In NH)
OVeddCmcfinn OFF
DEBRIPFION OF OPEMI%Mi94elwr
MIA
410472
BLANKET WAIVE
OF SUBROGATION
0510112014
05/0112015
X RY LIMITS ER
E.L. EACH ACCIDENT
E Soo 00
MPLOYE
E.L. DISEASE - EA EMPLOYEE
S Soo
E.L. OISFASE -PoLICT LIMIT
1 $ 500.000
DESCRIPTION OF OPERATONSI LOCATWMS IWHICLCB (AMaM ACOR01m, M®tlantl Rnm„lu SnMtlula, N mw .'.I„qulMl
SHOULD ANY OF ME 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 S80
Fort Collins, CO BOS22
All
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