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AC-"RV DATE(MWDDNYYY)
� CERTIFICATE OF LIABILITY INSURANCE F12/11/2024
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 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 endorsements).
PRODUCER CONTACT Scott Labat
NAME:
Willis Towers Watson Midwest, Inc. PHONE 1-877-945-7378 FAX 1-888-467-2378
c/o 26 Century Blvd A/C No
P.O. Box 30SI91 ADDRESS: certificates@willis.com
Nashville, TN 372305191 USA INSURER S AFFORDING COVERAGE I NAIC rp
INSURERA: Arch Insurance Company 31150
INSURED INSURERB: Arch Indemnity Insurance Company 30830
Retail Construction services, Inc. . -
11343 39th et N INSURERC:
Lake Elmo, MN 55042 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:W36572762 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.
[NSA ADDL'WVD POLICY NUMBER MMroD YYY11 Y MMroD YYYY 'LTR TYPE OF INSURANCE LIMITS
X COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ 1,000,000
! I DAMAGE TO RENTED
CLAIMS-MADE X! OCCUR PREMISES LEa occurrenceL $ 300,000
A MED EXP(Any one person) $ 15,000
51PKG8988502 12/31/2024 12/31/2025 i PERSONAL 8 ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICY X JE X LOC PRODUCTS-COMP/OP AGG S 2,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
(Ea ac---_-
cid 1,000,
ANY AUTO BODILY INJURY(Per person) !$
A OWNED SCHEDULED 51PKG8988502 12/31/2024 12/31/20251 BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED X NON-OWNED PROPERTYDAMAGE $
X AUT08 ONLY AUTOS ONLY 11Per accident-_
$
UMBRELLA LIABI X OCCUR EACHOCCURRENCE $ 10,000,000
A
X EXCESSLIAB CLAIMS-MADE S1UFP8988502 12/31/2024 12/31/2025, AGGREGATE 10,000,000
DED Xj RETENTION$0 is
WORKERS COMPENSATION X I ER OTH-
TU
B ANYPROPR(Mandatory yl MBE PARTNER EXECUTIVE Y/N E L.DISEASE.EA EMPLOYEE $ 1,000,000
AND EMPLOYERS'LIABILITY
In NH)
E L EACH ACCIDENT
OFFICEFUMEMBEREXCLUDED? No 'NIA 51WCI2091500 12/31/2024 12/31/2025� + -
I$ 1,000,000
II yes,describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS)VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required)
Re: Permit and License Purposes.
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.
City of Fort Collins AUTHORIZED REPRESENTATIVE
281 N. College Ave.
Fort Collins, CO 80524 -- r
01988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
SR ID: 26892568 BATCH: 3737571
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