HomeMy WebLinkAboutAMERICAN MECHANICAL SERVICES OF DENVER LLC - INSURANCE CERTIFICATE (5)ACORO® CERTIFICATE OF LIABILITY INSURANCE
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DATE (MMIDDIYYYY)
2/29/2016
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 endorsements .
PRODUCER
M&T Insurance Agency, Inc.
41 University Drive, Ste. 405
Newtown PA 18940
CONTACT
NAME: Diane Case
PHONE 215-504-1215 Fix 215-504-1235
E-MAIL dccasey@mtb.com
INSURER(S) AFFORDING COVERAGE
NAIC It
INSURER A:Old Republic Insurance Co.
24147
INSURED AMER117
INSURERS: North River Ins Company
21105
American Mechanical Services of Denver, LLC
INSURER c:Great American Ins. Co.
16691
Branch #9307
6810 S. Tucson Way
INSURER D:
Centennial CO 80112
INSURER E:
INSURER F:
COVFRAGFS CERTIFICATE NtIMRER- 1957325311 RFVISION NIIMRFR-
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
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
POLICY EFF
WDDNYYY
POLICY EXP
MMIDDNYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
Y
Y
MWZY306241
3/112016
3/1/2017
EACH OCCURRENCE
$1,000,000
CLAIMS -MADE �X OCCUR
PREMISES(EERaoccurrence
$500,000
X
MED EXP (Anyone person)
$10,000
Contractual Uab
X
No XCU Exclusion
PERSONAL & ADV INJURY
$1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
E2,000,000
POLICYO JEST LOC
PRODUCTS - COMP/OP AGG
$2,000,000
$
OTHER:
A
AUTOMOBILE LIABILITY
Y
Y
MW7B306240
3I1I2016
3/1/2017
Eaaccdern
$1,000,000
BODILY INJURY (Per person)
$
X ANY AUTO
AUTOS�ED SCHEDULED
BODILY INJURY (Per accident)
$
X HIRED AUTOS X NON -OWNED
AUTOS
Per accident
E
f
B
UMBRELLA LIAB X
OCCUR
Y
Y
5821047459
3/1/2016
3/1/2017
EACH OCCURRENCE
s20,000,OOO
X
AGGREGATE
s20,000,000
EXCESS LIAB
CLAIMS -MADE
DED RETENTION$
$FOLLOWS FORM
A
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY YINANY
y
MWC30623900
3/1/2016
3/1/2017
X PER OTH-
STATUTE ER
OFFICER/MEMBEEREXCLUDED7PROPRIETOPIPARTNER/EXECUTIVE I
NIA
E.L. EACH ACCIDENT
E1,000,000
E.L. DISEASE - EA EMPLOYEE
$1,000,000
(Mandatory in NH)
It yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$1,000,000
C
Installation Floater
Y
MAG1594285
1/1/2016
3/1/2017
All Risk $500,000
Leased/Rented Equipment
Y
Leased/Rented Equip $100,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
Commercial General Liability Policy Endorsements:
CG2010-0413-Additional Insured -Owners, Lessees or Contractors -Scheduled Person or Organization;
CG2037-0413-Additional Insured -Owners, Lessees or Contractors -Completed Operations;
CG2404-0509-Waiver of Transfer of Rights of Recovery Against Others To Us;
Automobile Liability Policy Endorsements:
CA2048-1 013- Designated Insured for Covered Auto Liability Coverage;
See Attached...
City of Fort Collins
281 N. College Ave., PO Box 580
Fort Collins CO 80526
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 EPRESENTA7IVE
` Q- `
01988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: AMERII7
LOC #:
AC C>
ADDITIONAL REMARKS SCHEDULE
Page 1 of 1
AGENCY
NAMEDINSURED
M&T Insurance Agency, Inc.
American Mechanical Services of Denver, LLC
Branch #9307
6810 S. Tucson Wayy
POLICY NUMBER
Centennial CO 80112
CARRIER
NAIL CODE
EFFECTIVE DATE:
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE
1013-Waiver of Transfer of Rights of Recovery Against Others To Us (Waiver of Subrogation);
Compensation Policy Endorsements:
13-Waiver of Our Right to Recover From Others Endorsement
ACORD 101 (2008/01)
0 2008 ACORD
The ACORD name and logo are registered marks of ACORD
All rights reserved