HomeMy WebLinkAbout110001 HIGH PLAINS MECHANICAL SERVICES - INSURANCE CERTIFICATEACORfX CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
�� 4/1/2019
3/23/2018
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 have ADDITIONAL INSURED provisions or 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 Lockton Companies
444 W. 47th Street, Suite 900
Kansas City MO 64112-1906
(816) 960-9000
CONTCT
NAME:
PHONE
INC, No, Ext : A/C, No
E-MAIL
ADDRESS:
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A: Old Republic Insurance Company
24147
INSURED High Plains Mechanical Service, Inc.
1398315 2020 Airway Avenue
Fort Collins CO 80524
INSURER B : Great American Insurance Company
16691
INSURER C : Zurich American Insurance Company
16535
INSURER D : Steadfast Insurance Company
26387
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: 13545069 REVISION NUMBER: XXXXXXX
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
INSD
SUBR
INVD
POLICY NUMBER
POLICY EFF
MMIDDNYYY
POLICY EXP
MMIDDIYYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
Y
Y
A-7CG-094918-03
4/1/2018
4/l/2019
EACH OCCURRENCE
1,000,000
CLAIMS -MADE � OCCUR
PREMISES (ETO a occur ence
300,000
MED EXP (Any oneperson)
10 000
PERSONAL & ADV INJURY
$ 1,000,000
GEN-L AGGREGATE LIMIT APPLIES PER:
POLICY PE ❑ LOC
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
OTHER:
A
AUTOMOBILE
LIABILITY
Y
Y
A-7CA-094918-03
4/1/2018
4/1/2019
aBINEDtSINGLE LIMIT
(Ea
$ 2,000,000
X
BODILY INJURY (Per person)
$ XXXXXXX
ANY AUTO
OWNAAUTOS ONLY SCHEDULED
BODILY INJURY (Per accident
$ XXXXXXX
HIRED AUTOS ONLY AUUTOS ONLDY
PROPERTY
acctlentDAMAGE
$ XXXXXXX
$ XXXXXXX
B
X
UMBRELLA LIAB
X
OCCUR
N
N
T000189267- 07
4/1/2018
4,1;2019
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 5,000,000
EXCESS LIAB
CLAIMS -MADE
DIED I I RETENTION $
$ XXXXXXX
A
WORKERS COMPESATION AND EMPLOYERS' LIABILIITY YIN
OFFICERlMEMBANY 6RlEXCLUDED? ECUTIVE N❑
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
Y
A-7CW-094918-03
4/1/2018
4/1/2019
X PER o R
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE Is
1,000,000
E.L. DISEASE - POLICY LIMIT Is
1,000,000
D
C
POLLUTION LIAB
INSTALLATION FLTR
N
N
EOC 5833423-06
CPP 4886518-08
4/1/2018
4/l/2018
4/1/2019
4/1/2019
POLL-OCC/AGG 2,000,000
INSTL - LIMIT 1,500,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CITY OF FORT COLLINS IS AN ADDITIONAL INSURED WITH RESPECT TO THE GENERAL AND AUTO LIABILITY COVERAGE, WHICH IS
PRIMARY COVERAGE TO THE ADDITIONAL INSURED AND OTHER AVAILABLE INSURANCE WILL BE NON-CONTRIBUTORY AS REQUIRED
BY CONTRACT. SUBROGATION RIGHTS ARE WAIVED IN FAVOR OF THE CERTIFICATE HOLDER AS REQUIRED BY CONTRACT AND WHERE
ALLOWED BY LAW.
l.CR 1Ir Il MIG rIVLV CR I,HIV I,CLLH I IVIY
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
13545069 AUTHORIZED REPRESENTATIVE
CITY OF FORT COLLINS
215 N MASON ST
PO BOX 580
FORT COLLINS CO 80522
f..
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