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HomeMy WebLinkAboutLAKESIDE MECHANICAL SERVICE INC - INSURANCE CERTIFICATE (7),a►co CERTIFICATE OF LIABILITY INSURANCE FDA4TE(MM/DDI /26/201818 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 CONT__NAMEACT Karole Peters Ewing -Leavitt Insurance Agency, Inc. PHONE (970) 679-7355 FAX No: (866)237-2178 4090 Clydesdale Parkway ADD�RESS:karole—peters@leavitt.com Suite 101 INSURERS AFFORDING COVERAGE NAIC 0 Loveland CO 80538 INSURERA:Secura Insurance 122543 INSURED INSURER B :Pinnacol Assurance 41190 Lakeside Mechanical Service, Inc. INSURERC: 1008 Engleman Place INSURERD: INSURER E : Loveland CO 80538 INSURERF: COVERAGES CFRTIFICATF NIJURFP-18-19 UPDATE DGVICInAi KI ueDCD• 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 ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X� OCCUR Blkt Additional Insured TC3189005 2/23/2018 2/23/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 500,000 X MED EXP (Any one person) $ 5 , 000 X Blkt Waiver of Subro PERSONAL BADVINJURY $ Included GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ECT LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 7 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS A3189006 2/23/2018 2/23/2019 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY Per accident ( ) $ X PROPERTY DAMAGE Per accident $ sin le limit $ A X UMBRELLA LAB CESS LIAB X OCCUR CLAIMS -MADE CU3189007 2/23/2018 2/23/2019 EACH OCCURRENCE $ 5,000,000 L] AGGREGATE $ 5,000,000 LDEDI X I RETENTION$ 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y� OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N 1 A 4104726 Blanket Waiver of Subrogation 5/1/2018 5/1/2019 X SPER OTH- TATUTE ER E.L. EACH ACCIDENT $ 500 000 EL. DISEASE - EA EMPLOYE $ 50- 000 -- - E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached 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 role Peters/KAPETE �� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INSMS r9M AMA