Loading...
HomeMy WebLinkAboutNorth Front Range Metropolitan Planning Organization - Insurance CertificateSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME: CONTACT (A/C, No): FAX E-MAIL ADDRESS: PRODUCER (A/C, No, Ext): PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT ER OTH- STATUTE PER LIMITS(MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) POLICY EFF POLICY NUMBERTYPE OF INSURANCELTR INSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 1,000,000 1,000,000 751668234 751668234 419 Canyon Ave., Suite 300 City of Fort Collins Purchase Division 500,000,000 01/01/26 X 01/01/26 Property (Primary) 10,000,000 1,000,000 Property (Excess Prop) Certificate Holder is Additional Insured on Liability Policies if required by contract. 1-303-757-5475 X The City of Fort Collins, it's officers, agents and employees are added as additional insured for any claims arising With respects to new VanGo service between the City of Fort Collins and North Front Range MPO, as service provider. out of the work performed under this agreement. 01/01/25 USA 01/01/25 01/01/26 North Front Range MPO EWC010071 01/01/25 10,000,000 01/01/26X X Moniquef X 10,000,000 Fort Collins, CO 80527 3665 Cherry Creek North Drive 0$10m POL E&O Aggregate Midwest Employers Casualty Company CIRSA See Attached Schematic 10,000,000 C A 01/01/24 LIAB 01-2025 X 01/01/25 Fort Collins, CO 80521 USA N B A Prop Pool Limit LIAB 01-2025 5,000,000A 01/09/2025 PR 01-2025 See Attached Schematic X 1,000,000 LIC #N/A P.O. Box 580 Denver, CO 80209 USA 01/01/26 CIRSA Insurer A.Lloyds Syndicates - HCC (9%); Rokstone (3.5%); Liberty (2.5%); Hardy (3.5%) ; Convex (3.5%); Alchemy (2.5%); Sompo (4%); QBE (1%); Inigo (4%); Brit (5%); Dale Dual (2%); AMP (2%); Dale Property (2.5%); Fidelis (2.5%); Ark (2%); Marine Ins. (1.5%) Policy Number B1230AP13307A25 Insurer B. Canopius US Insurance, Inc. (NAIC#: 12961) Policy Number: CUS30000189-01 Insurer C.Ironshore Specialty Insurance Company (NAIC#: 25445) $200 Million x $200 Million Policy Number: 1000368384-06 Insurer D. Everest Indemnity Insurance Company (NAIC#: 10851) Policy Number: CA3P006325-251 Insurer E.Allied World Assurance Company (U.S.), Inc. (NAIC#: 19489) Policy Number: 0314-1183-1A Insurer F.Lloyds Syndicates - Axis (7.5%); Unicorn (5.5%) Policy Number: B1230AP13307C25 Insurer G.Lloyds Syndicates - TM Kiln (9%); Beazley AFB (4%) Policy Number: B1230AP13307B25 Insurer H.The Princeton Excess and Surplus Lines Insurance Company (NAIC#: 10786) Policy Number: N1-A3-PP-0000078-00 Insurer I. & T.HDI Global Insurance Company (NAIC#: 41343) Policy Number: CPD5542206 (I) & CPXD5444607 (T) Insurer J.Steadfast Insurance Company (NAIC#: 26387) Policy Number: CPP-3279796-04 Insurer K. Evanston Insurance Company (Markel) (NAIC#: 35378) Policy Number: MKLV2XPR002526 Insurer L.Lexington Insurance Company (AIG) (NAIC#: 19437) Policy Number: 0006893580 Insurer M.Axis Surplus Insurance Company (NAIC#: 26620) Policy Number: P-001-000469722-01 Insurer N. Fidelis (London) Policy Number: B1230AP13307E5 Insurer O.Lloyds Syndicates - Atrium (10%); Ki (2%); AMP (2.5%) Policy Number: B1230AP13307D24 $25 Million x $25 Million Insurer P. & S.Great American E&S Insurance Company (NAIC#: 37532) Policy Number: 2480063-05 (P&S) Insurer Q.Mitsui Sumitomo Insurance Company of America (NAIC#: 20362) Policy Number: EXP7001347 Insurer R.Fidelis (London) (20%); Inigo (5%) AMP (5%) Policy Number: B1230AP13307F5 Insurer U. Obsidian (NAIC#: 16871) Policy Number: AWR-PR-0000010-00 $10 Million Insurer V.RSUI Indemnity Company (NAIC#: 22314) Policy Number: NHD948242 $5 Million Self-Insured Retention Insurer W.Chubb Europe SE Policy Number: B1230AP13307H25 $1 Million Self-Insured Retention Insurer X.Liberty Surplus Insurance Corporation (NAIC#: 10725) Policy Number: 5N435476002 CIRSA Property Coverage Schematic (S ) G r e a t A m e r i c a n - ( 1 2 . 5 % ) (T ) H D I - ( 1 5 % ) (U ) O b s i d i a n - ( 7 . 5 % ) (Q ) M i t s u i - ( 3 5 % ) (R ) F i d e l i s - ( 3 0 % ) (W) Chubb Europe SE - (100%) (X ) T e r r o r i s m C o v e r a g e - L I U Te r r o r i s m ( T R I A ) C o v e r a g e i n c l u d e d i n ( V ) a n d ( W ) (V) RSUI - (100%) (G ) L l o y d s (L e d b y T M Ki l n ) - ( 1 3 % ) CIRSA - $5M Wind and Hail SIR $100 Million x $100 Million 1/1/2025 to 1/1/2026 Layer $100 Million x $400 Million (F ) L l o y d s - Le d b y A x i s - (1 3 % ) (D ) E v e r e s t - ( 5 % ) (E ) A W A C - ( 5 % ) $25 Million (A ) L l o y d s ( L e d b y HC C ) - ( 5 1 % ) $50 Million x $50 Million (P) Great American - (100%) (K ) M a r k e l - ( 2 0 % ) (L ) L e x i n g t o n - ( 3 0 ) % (H ) M u n i c h - ( 5 % ) (I ) H D I ( 6 % ) (J ) Z u r i c h ( 5 % ) (M ) A x i s - ( 9 . 5 % ) (N ) F i d e l i s - ( 1 0 % ) (O ) L l o y d s ( L e d b y At r i u m ) - ( 1 4 . 5 % ) CIRSA - $1M Per Occurrence Self Insured Retention (SIR) (B ) C a n o p i u s - ( 5 % ) (C ) I r o n s h o r e - ( 5 % )