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HomeMy WebLinkAboutINNOVATIVE MECHANICAL SOLUTIONS INC - INSURANCE CERTIFICATE (4)INNOV-9 OP ID: DA ACORD" r ATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE TE(MMI DIYY 017 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: Diana Vigil Brown & Brown Inc PHONE 970-482-7747 FAX: 970-484-4165 4532 Boardwalk Dr, Suite 200 aC NoNE Nd Fort Collins, CO 80525 RI ADDESs: dvigil@bnbcolorado.com William S. Rich - INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: UNITED FIRE GROUP INSURED Innovative Mechanical INSURER B: Pinnacol Assurance Company 41190 Solutions Inc. 10650 Irma Drive, Unit 9 INSURERC: Northglenn, CO 80233 INSURERD: INSURER E : INSURER F : rnVFRAr.FS CFRTIFICATF Nt1MBFR- REVISION NUMBER - THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN !SSUED 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 IN UBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE a OCCUR 60489087 04/01/2017 04/01/2018 DAMAGE TO RENTED PREMISES Ea occurrence E 2,50U,UU MED EXP (Any one person) $ 6,00 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 JPRO- POLICY X LOC PRODUCTS - COMP/OP AGG $ 2,000,00 Emp Ben. $ 1,000,00 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000 00 BODILY INJURY (Per person) $ A X ANY AUTO 60489087 04/01/2017 04/01/2018 BODILY INJURY (Per accident) $ $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Peraccident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 A EXCESS LIAB CLAIMS -MADE 60489087 04/01/2017 04/01/2018 DED I X RETENTION$ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 4163586 04/01/2017 04/01/2018 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N f A E.L. DISEASE - EA EMPLOYEE $ 1,000,00 It yes, descn be under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,00 A Installation 60489087 04/01/2017 04/01/2018 Install 20,00 A Leased/Rented Eq 60489087 04/01/2017 04/01/2018 �Lsd/Rntd 100,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER City of Fort Collins 215 N. Mason St. Fort Collins, CO 80521 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 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INNOV-9 PAGE 2 NOTEPAD INSURED'S NAME Innovative Mechanical OP ID: DA Date 03/28/2017 The following apply if required by written contract: Commercial General Liability: Blanket Additional Insured - Ongoing Operations - CG7151 Blanket Additional Insued - Completed Operations - CG7176 Primary & Non -Contributory Coverage - IL7105 Blanket Waiver of Subrogation - Form CG7151 Per Project Aggregate - Form CG7151 Per Location Aggregate - Form CG7151 Commercial Automobile: Blanket Additional Insured - Form CA7109 Blanket Waiver of Subrogation - Form CA7109 Primary and Non -Contributory Coverage - CA7334 Commercial Umbrella: Following Form Workers Compensation: Blanket Waiver of Subrogation - Form 359b