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HomeMy WebLinkAboutHARPER MECHANICAL INC - INSURANCE CERTIFICATE (2)HARPE-2 OP ID: LU Al �RO DATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 11/17/2017 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 CONTANAME: CT House Account Brown & Brown Inc PHONE FAX 4532 Boardwalk Dr, Suite 200 A/c No Ell:970-482-7747 Iuc No : 970-484-4165 Fort Collins, CO 80525 E-MAIL House Account ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Westfield Insurance Company 24112 INSURED Harper Mechanical, Inc. INSURER B: Pinnacol Assurance Company 41190 4604 Bush Mills Ave. Evans, CO 80634 INSURERC: INSURER D : INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER- REVISION NLIMRFR! 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 I SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR X CWP5500473 10/01/2017 10/01/2018 EACH OCCURRENCE $ 1,000,00 ( RENTED PREMEa occurrence PREMISES 50O OO r $ MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 1,000,00 L AGGREGATE LIMIT APPLIES PER: PRO ❑LOC IOTHER GENERAL AGGREGATE $ 2,000,00POLICY PRODUCTS - COMP/OP AGG $ 2,000,0OJECT: $ A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS I CWP5500473 10/01/2017 10/01/2018 COMBINED SINGLE LIMIT Ea accident $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Peraccident $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CWP5500473 10/01/2017 10/01/2018 EACH OCCURRENCE $ 3,000,00 AGGREGATE $ 3,000,00 DIED I X I RETENTION $ 10000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 4169725 12/01/2017 12/01/2018 PER OTH- X STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE -POLICY LIMIT 1 $ 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) r'FRTIFIr_ATF Hr11 nF=p r:ANrFI I ATIr1N CITYFC1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. 281 N. College Ave Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE House Account ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD NOTEPAD H INSURED'S NAME Harper Mechanical, Inc. OPP ID: D: LU If required by contract the following forms apply: General Liability CG 2001 (04/13)- Primary Non Contributory CG 2010 (04/13)- Blanket Additional Insured Ongoing Operations CG 7133 (02/11)- Blanket Additional Insured Completed Operations CG 7143 (11/12)- Blanket Waiver of Subrogation CG 2503 5/09 - Per Project Aggregate Business Auto CA0444- Blanket Waiver of Subrogation CA7078- Blanket Additional Insured Workers Compensation 359-B- Waiver of subrogation Umbrella - Follows Form - if coverage on underlying, umbrella responds PAGE 2 Date 11 /17/2017