HomeMy WebLinkAboutLAKESIDE MECHANICAL SERVICE INC - INSURANCE CERTIFICATE 2023-2024� � OATE�MHWP7YYYY)
4`� D CERTIFICATE OF LIABILITY 1NSURANCE q/21/2023
THIS CERTIFICATE IS kSSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON 7HE CERTIFICATE HOLDER. THIS
CERTlfICATE DOES NaT AFFIRMAT4VEL.Y 012 NEGATIVELY AMENQ, EXTEND QR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CQNTRACT BETWEEN THE ISSUING INSURER(Sy, AkJTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICA7E HOLDER.
IMPORTANT: If the certificate hoider is an AD�ITIONAL INSURE�, the policy(ies) must be endorsed. 1f SUBROGATION IS WAIVED, subject to
the terms and conditions af the policy, certain policies may require an endorsement. A statament on this certificate does nok confer rights ta the
certificate holder in lieu of such endorsement(s}.
PRODIICER NAME: P� �egP$1
Ewing-Leavitt Tnsu=ance Agency, Inc. PKONE ,(g70) 679-7355 �C Ha: 846 337.Z178
4090 Clydesdale Pa=kr�ray E'Ai1Ai�� nm-knes el@leavitt.com
ADDRESS: p p
$u14.e 141 INSURER 5 AFFORDING COVERAGE HAIC N
Loveland CO 80538 INSURERA: SECURA Insurance A Mutual Co an 22543
INSURED INSURER 9: P1RI1IIC01 A8811SdRC@ 41190
Lakesida Mechaniaal Service, Ine. INSIIRERC:
1008 Englema� Plaee tNsuaeR o:
Loveland CO 80538 INSURERF:
COVERAGES CERTIFlCATE NUMBER:23-24 REVISION NUMBER:
iH15 IS'�O CEHI IhY THAi THE POLii.IES OF INSl3RANCC LIS7Eil S�L"J1N HI4VE SEEN ISSISED TO ?HF 1NSURFD NAMED ABOVE FQR THE POLICY ?ERIOp
INDICATED. NOTWITHSTANDING ANY REQUIREMEiVT. TERM OR CONDITIOM �F ANY CONTRACT OR OTHER POCUMENT WITH f2ESPECT TO WHICH 7HIS
CERTIFICATE MAY BE ISSVED OR MAV PERTAIN, THE INSURANCE AFFORDED BY THE POLIGIES �ESCRIB@D HEREIN IS SUB.lECT TO ALL THE TtiRM5,
EXCLUSIpNS AND CON6ITION5 OF SUCH POLIC3ES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR AUOL SUBR POLICY EFF POLtCY EI[P LIMIfS
�YR 7YPE OF INSURANCE POLICY Nl1MBER MNWDIYYYY MMID�lYYYY
X COMMERCWL GENEFiAL LIA6ILITY EACH OCCURRENCE $ 1, 060 , 000
AMA E RENT@D g 500,000
A CLAIMS-MAOE � OCC[1R PREMlS@S @a occvrrence
X Bkkt Additioaal Ineured 20-xc-o03189005-13 2l23/2023 2/23/2024 MEO FJ(P (My one persony 3 5,400
X Blkt Naiver of Subrogation PERSONAL 8 AOV fNJURY $ 1, 000, 000
GEN'LAGGREGATELIMITAPPLIESPER GENERALAGGREGATE ; 2,000,000
POLICY PR� PRODUC75-COMP/OPAGG S
2,000,000
a JECT LOC S
OTHER:
AUTOMOBILELWBfLI7Y CO aB�INdEB'SINGLELIMIi S 1,000,000
X ANYAU70 BORILY INJl1RY (Per person) S
A n,Lt pyVh7EU SCHE�ULEb
AUTOS AUTOS 20-A-003189005-13 2/23/2023 2/23/2024 80DILY INJURY (Per accident� S
NON-OWNE� PROPERTY �AMAGE 5
Per a 'dent
X HIREDAUTOS x AUTOS $
X BlktAd6'I InsureE X B�kt WaWer W SuMo
]( i1M9RELLALIA9 X OGGUR EACH OCCURREhCE 3 5 000 000
A EXCESS LIA6 CLAIMS-MADE AGGREGATE S 5 000 000
DED X RETEN710N S 10 000 YO-CU-003189007-13 2/23/2023 2/23l2024 ;
WORKERS COMPEMSATION PER OTFt-
InClud�s Blkt i1aiV�x of Subso X ST T T
ANO EMPLOYERS' LIABILITY Y 1 N
ANY PROPRiETDRIPAR7NERIEXECUTtVE E L EACH ACCIDENT S 500 , 000
OFFICERIMEMBEREXCWDEq7 ❑ N!A
H �Mandaloryin NHj �104726 5/1/2623 5/1/202{ E.L DISEASE • EAEMPLOYEE 5 SD0,000
If yes. deurihe under E.L DISEASE - POLICY LIMIT S 500 000
QESCRIP710N OF OPERATIONS below
DE5CRIPTION OF OPERATIONS f lOCA7i0N51 VEMICLES (ACORD 101. AAditlonal RamarN� Schadule, may be attachW i1 mon spacr it raQuirad)
CERTIFiCATE HOLDER CANCfLLATION
City of Fart Collins
PO Box 5$0
Fort Collins, CO 80522
cgov.com �
SHOULD ANY OF THE A80VE DESCRIBED POLICIES BE GANCELLED BEFORE
THE EXPIRA710N DATE THEREOF, kOTICE WIU. BE DELIVERED tN
ACCORUANCE WITH THE POLICY PROYISIONS.
AUTHORIZED REPRESENTATNE
�'f�,rcc�.� ,a+ �iie�oc,Q
pORATION. All rights re
Pam Knespel'PAKNES
ACdRD 25 (2014l01�
INS025 [2otao�)
� 19$$-2D14 ACOR�
The ACORD name and logo are registered marks of ACORD