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CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/VYYY)
FINSURED
IS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE C13/2024
ERTIFICATE HOLDER. THIS
RTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
LOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
PRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
ORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(fes)must have ADDITIONAL INSURED provisions or be endorsed.
IfUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
CER
s Towera Watson Midwest, Inc. ONTA T
NAME: WTW Certificate Center
6 Century Blvd PHONE --
ox 305191 1-877-945-7378 A
EMAIL A/C No: 1-888-467-2378
lle, TN 372305191 uSA A RESS: certificates@wtwco.com
INSURERS AFFORDING COVERAGE
INSURERA: Zurich American Insurance Company NAIC#
D 16535
ma
ikeamar CompanyINSURERS: AXIS Surplus Insurance Compareike Colalillo Drive Y i 26620
Duluth, MN 55907 INSURER C: ---'t-
i
INSURER 0: -
INSURER E:
COVERAGES INsuRERF: --- -- ------
CERTIFICATE NUMBER:W36631703
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREDENAISION M D ABOVE FOR OR THE POLICY PERIOD
ICERTIFICATE MAY BE ISSUED OR MAY NDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
III OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_.
LTR XCLUSIONSTANE CONDITIONS C - AODL-SaW
POLICY NUMBER AAIO ppryYYY MM�DYYYYY —
X COMMERCIAL GENERAL LIABILITY
LIMITS
_T I CLAIMS-MADE X I OCCUR EACH OCCURRENCE I$ 2,000,000
A
X i Contractual Liability PREMISES a ocq rrence�_ $ 2,000,000
Y GLO 8902940-05 12/31/2024 12/31/2025 MED EXP(Any one person) $ 10,000
GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $ 2,000,000
POLICY j X JEC L___j LOC GENERAL AGGREGATE
$ 4,000,000
-------
AUTOMOBILE LIABILITY ---
OTHER: PRODUCTS-COMP/OP AGG $ 41000,000
$
X ANY AUTO COMBINED SINGLE LIMIT
a accldenlL__ $ 5,000,000
A OWNED SC
HE 1EDULED Y BODILY INJURY(Per person) $
AUTOS ONLY AUTOS BAP 8488453-05 12/31/2024 12/31/2025
HIRED X NON-OWNED BODILY INJURY(per accident) $
X!AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
f-Per accident)- - —-- $--
- ..
B UMBRELLA LIAB X OCCUR Is
X EXCESS LI AB CLAIMS-MADE P-001-000068228-07 EACH OCCURRENCE $ 5,000,000
�� -- 12/31/2024I12/31/2025
DED RETENTION$ (AGGREGATE J$ 5,000,000
WORKERS COMPENSATION --AND EMPLOYERS'LIABILITY I$
A 'AN VPROPRIETOWPARTNER/EXECUTIVE Y/N P i O H-
OFFICERWEMBEREXCLUDED? No x! STATUTE ! ER
(Mandatory In NH) N A WC 8902941-05 E.L.EACH ACCIDENT $ 5,000,000
ff es,describe under 12/31/2024 12/31/2025 - I
-E.L.DISEASE-EA EMPLOYEEI$
D SCRIPTION OF OPERATIONS bebw - _ 5,000,D00
A !Installation Floater E.L.DISEASE-POLICY LIMIT $ 5,000,oo0
MBR 0084170-09 05/01/2024 05/01/20251Limit
$1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required)
i
SEE ATTACHED
L____
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
LC'ty of Fort Collins AUTHVR14tV REPRESENTATIVE
0. Box 580
Collins, CO 80521 l�"1~ sly
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORDORD CORPORATION. All rights reserved.
sn ID: 26878230 9ATCH: 3741888
AGENCY CUSTOMER ID:
LOC#:
AC R® ADDITIONAL REMARKS SCHEDULE
Page 2 of 2
NAMED INSURED
AGENCY The Jamar Company
4701 Mike Colalillo Drive
Willis Toward Watson Midwest, Inc- Duluth, NN 55807
POLICY NUMBER
See Page 1 NAIC CODE
CARRIER See Page 1 EFFECTIVE DATE:See Page 1
See Page 1
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
25 FORM TITLE: Certificate of Liability Insurance y y Policies
FORM NUMBER: _____--
City of Fort Collins is included as Additional insured urnider the General
riorLtobthetlossa Automobile Liability p
when required by written contract, agreement or permit
NAICN: 16535
INSURER AFFORDING COVERAGE: Zurich American Insurance Company
POLICY NUMBER: CPP 0084169 - 09 EFF DATE: 05/01/2024 EXP DATE: 05/01/2025
LIMIT AMOUNT:
TYPE OFF LIMIT DESCRIPTION: $1,000,000
Leased/Rented Equipment Any One Item/Per Occ
Sea Below
Deductible
ADDITIONAL REMARKS:
$10,000 Per Occurrence < $250,000 item value; $50,000 per Occurrence > $250,00
Leased/Ranted Equipment Deductible:
item value; $50,000 for Theft.
-------------
®2008 ACORD CORPORATION. All rights reserved.
ACORD 101 (2008/01)
The ACORD name and logo are registered marks of ACORD
SR ID: 26878230
BATCH:3741888 CERT: W36631703 11208: 2