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HomeMy WebLinkAboutLAKESIDE MECHANICAL SERVICE INC - INSURANCE CERTIFICATE (4)A� D� CERTIFICATE OF LIABILITY INSURANCE 4/28/2015Y) 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 Karole Peters NAME PHONE AJC (970) 679-7355 FAX No: (866)237-2178 E-MAIL .karole-petersQleavitt.com INSURERS AFFORDING COVERAGE NAIC # INSURERA:Secura Insurance 22543 INSURED Lakeside Mechanical Service, Inc. 900 Engleman Place Loveland CO 80538 INSURERB:Plnnacol Assurance 41190 INSURERC: INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:15-16 WC Update 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. INSR LTR OF INSURANCE LSUBR ADDTYPE POLICY NUMBER POLICY EFF MMIDDIVYYV POLICY EXP MM/DD/YVVV LIMITS GENERAL LIABILITY TC3189005 /23/2015 2 /23/2016 EACH OCCURRENCE $ 11000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx_1 OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 500,000 MED EXP (Any one person) $ 5,000 PERSONAL BADVINJURY $ Included X Blkt Addl Insured X Blkt Waiver of Sub GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY X PRO LOC $ AUTOMOBILE LIABILITY 3189006 /23/2015 2 /23/2016 COMBINED t SINGLE LIMIT 1,000,000 BODILY INJURY (Per person) $ A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS Ix BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per acci ent $ X NON -OWNED HIRED AUTOS AUTOS Uninsured motorist combined S X UMBRELLA LIAB X OCCUR 3189007 /23/2015 /23/2016 EACH OCCURRENCE $ 51000,000 AGGREGATE $ 5,000,000 A EXCESS LIAB CLAIMS -MADE DEC) X RETENTION$ 10,00 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNER'EXECUTIVE 4104726 Waiver of 5/l/2015 5/l/2016 X WC STATU- I OTH- E.L. EACH ACCIDENT $ 500,000 ❑Blanket OFFICER/MEMBER EXCLUDED? (Mandatory In NH) N/A Sularogation E.L. DISEASE -EA EMPLOYE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS Indio, E.L. DISEASE -POLICY LIMIT $ 50(),000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) City of Fort Collins PO Box 580 Fort Collins, CO 80522 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 Peters/KAPETE �4111_ ACORD 25 (2010105) INS025 ('01005) 01 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD