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HomeMy WebLinkAboutLAKESIDE MECHANICAL SERVICE INC - INSURANCE CERTIFICATE (9)AC� ® DATE (MM/DD/YYYY) AC� CERTIFICATE OF LIABILITY INSURANCE 2/14/2018 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 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 CONTACT NAME: KarOle Peters Ewing -Leavitt Insurance Agency, Inc. P,oHic No.E><t): (970) 679-7355 I F No): (866)237-2178 4090 Clydesdale Parkway ADDRESS:karole-peters@leavitt.com Suite 101 INSURER 5 AFFORDING COVERAGE NAIC # Loveland CO 80538 INSURERA:Secura Insurance 22543 INSURED INSURER B :Pinnacol Assurance 41190 Lakeside Mechanical Service, Inc. INSURERC: 1008 Engleman Place INSURER D INSURER E : Loveland CO 80538 I INSURERF: COVERAGES CERTIFICATE NUMBER:18-19 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 TYPE OF INSURANCE ADoL POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER Y A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X Blkt Additional Insured TC3189005 2/23/2018 2/23/2019 EACH OCCURRENCE $ 1,000,000 GE 0 RENTED PREM SES LEa occur re $ - 500,000 MED EXP (Any one person) $ 5,000 X Blkt Waiver of Subro PERSONAL & ADV INJURY $ Included —GENT AGGREGATE LIMIT APPLIES PER: P , POLICY " JEST I LOC OTHER: [GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMPIOP AGG $ 2,000,000 — --- — - -- $ A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED X HIRED AUTOS X AUTOS A3189006 2/23/2018 2/23/2019 COMBINED SINGLE LIMIT Ea accident)-___ BODILY INJURY (Per person) $ 1,000,000 $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CU3189007 12/23/2018 2/23/2019 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED X RETENTION $ 10,000 1 $ g WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRWT;0N O. OPERAT:ONS below N I A 4104726 Blanket Waiver of Subrogation I 5/1/2017 5/i/2018 TH- X STATUTE ER E.L. EACH ACCIDENT $ 500,000 E.L DISEASE - EA EMPLOYEd $ 500,000 E.L. DISEASE - POLICY 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 PO Box 580 Fort Collins, CO 80522 1L.A1VlaLLA I IUN 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 Karole Peters/KAPETE 09<41-111� 'I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401)