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HomeMy WebLinkAbout165318 CMS MECHANICAL SERVICES INC - INSURANCE CERTIFICATE (9)CMSME-1 OP ID: JD ACORO' �� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 04/18/2017 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 Brown & Brown Inc 4532 Boardwalk Dr, Suite 200 CONTANAME: Jody Wagner _ PHONE g7O-482-7747 FAX 970-484-4165 A/C No Ext)• (AIC, No): E-MAIL jwagner@bbcolorado.com - Fort Collins, CO 80525 Tyler B. Allen -ADDRESS: _ INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Depositors Insurance Company 42587 INSURED CMS Mechanical Services, Inc. 609 Technology Circle, Suite A Windsor, CO 80550 INSURERS: AMCO Insurance Company 19100 INSURER C : Pinnacol Assurance Company 41190 INSURER D :Nationwide Mutual Insurance Co 23787 INSURER E : Philadelphia Indemnity Ins Co 18058 INSURER F : COVERAGES CERTIFICATE NUMBER: 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. LTR ILTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MM/ POLICY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE - $ 1,000,000 CLAIMS -MADE EK OCCUR X ACPGLD03036558176 04/27/2017 04/27I2018 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 E X Employment Pract PHSD1152431 07/18/2016 07/18/2017 MED EXP (Any one person) $ 10,000 (Intl 3rd Party) PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP/OP AGG $ 2,000,000 PR - POLICY FX] ECT LOC EPL Limit $ 1,000,00 OTHER: AUTOMOBILE LIABILITY COEa aMBINEDccident SINGLE LIMIT $ 1,000,000 � BODILY INJURY (Per person) $ A X ANY AUTO X ACPBAPD3036558176 04/27/2017 04/27/2018 BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 B EXCESS LIAB CLAIMS -MADE ACPCAA3036558176 04/27/2017 04/27/2018 DED X 7ETENTION$ 0 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A 4105092 06/01/2017 06/01/2018 PER X STATUTE ERH E.L. EACH ACCIDENT $ 1,000,00 0 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS bClu9 p Installation Fltr ACPCIM3036558176 04/27/2017 04/27/2018 Inst Fltr 50,000 Lsd/Rntd Equip Lsd/Rtd 50,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins is included as an additional insured per forms and conditions on page 2. CITYFT5 City of Fort Collins Purchasing P. O. Box 580 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 (2014/01) The ACORD name and logo are registered marks of ACORD NOTEPAD CM INSURED'S NAME CMS Mechanical Services, Inc. OP ID: D: JD The following apply when required by written contract: GENERAL LIABILITY: Additional Insured On -going & Completed Operations CG7246 11/15 Primary/Non-Contributory Wording CG7246 11/15 Blanket Waiver of Subrogation CG7158 08/04 Per Project Aggregate CG2503 05/09 AUTOMOBILE LIABILITY: Additional Insured AC7005 (03/16) Blanket Waiver of Subrogation AC7005 (03/16) RELLA LIABILITY: lowing form S' COMPENSATION: t Waiver of Subrogation 359-B PAGE 2 Date 04/18/2017