HomeMy WebLinkAboutDorian Studio - Insurance Certificate(:()Rn"
COVERAGES
CEHTIFICATE OF LIABILITY INSURANCE
CERTIFICATE NUMBER: 1437012778 HEVISION NUMBER:
oalE (Ix/oo|rYYY)
1D1nO25
TITIS CERTIFICATE IS ISSUED AS A MAITER OF INFOBMATION ONLY ANO CONFENS NO RIGHTS UPON THE CEHTIFICATE HOLDER, I}IIS
CEBTIFICATE DOES NOT AFFIRMATIVELY OR NEGANVELY Ai'ENO, EXTEND OR ALTEB THE COVERAGE AFFORDEO BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSNTUTE A CONTRACT BETWEEN THE ISSUING INSUBER(S), AUTHOBIZEO
REPBESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPOFTANT: ll the certlrlcate holdsr Is an ADDITIONAL INSUnED, the policy(les) must have ADDITIONAL INSUAED provisions or be endorsed,
lf SUBROGATION lS WAIVEO, gublect lo lhe terms and condltions ot the pollcy, cenaln pollcles may require an endorsemenl. A statemenl on
thls canlflcrie doea not confer rlghls to the cenlrlcste holder ln lleu ol such endorcement(s).
PBOOUCEF
Holmes lrurphy & Associates
2727 Grcrd Prairie Parkway
Waukee lA 50263
Jeannette Parrott
PHOTIE
esmu corn
_!r1 !!jlqaE9!!!!q!9!!!4qE NAE!
25615r suBEna: Charter Oak Fire lnsurance Corn an
INSI'BED
Raker Rhodes Engineerrng. LLC
4717 Grand Avenue
Des Moines lA 50312
ItsuFEF B: Travelers Prglgqcegq?rylg America 2567 4
I SUNEFC rig!g!q!4l!I! !!!! aly 19070
16820llisuREB o : SiriusPornt Specralty lnsurance Corp
I{SUNEE E :
THIS IS TO CERNFY 1HAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUR€O NAMED AAOVE FOB THE POLICY PEBIOO
INDICATED NOTWTHSTANOING ANY REOUIREI\,'ENT. TERM OR CONDITION OF ANY CONTHACT OR OTHER OOCUMENT WITH RESPECT TO WHICH THIS
CEBTIFICATE I\IAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES OESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONOITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REOUCEO BY PAIO CLAIMS.
LlltTsTYPEOFINSUAANCEPOiJCY NUMAEF
INSF POLICY EFF POLICY D(Ptt /t'ooYYYY) iiatlDo'YYYY)
ADDL SU6F
6806H809095 113112025 $2.000.000
PEESONAL & ADV INJUBY
$
GEN'L AGGAEGATE LIMIT APPLIES PER
OTFEA
LOC
113112026
l-!].!qo,qo.g
t 10.000
!49q0.9!q
!1,0q!,990
s4.000,000
GENEFAL AGGBEGAT.E
PRODUCTS. COMPIOP AGGpoLrcv x SPcoi
X COIIIIERCIALGEI.IEBAL IIABIltrY
cLrrus.urce X occun
EACHOCCUBRENCE'EffitrGEro-FwrFr -
. PE-EUISES E6.eeq'IJ!-i_'c-e)
ME0 EXP lA.t o.'. peGo.)
8A3R942852 1t31nO25 1131n026
AODILY INJUFY lPya@d€.1)
AU'TOItOEILE UAEILITY 51.000.000
SCHEOULEO- . Al.]Tosr1 NON OLINE 0
.J: AUIOS ONLY
s
;
t
PROPEATYOAMAGE
OWNED
--- AUIOS o|ILYY HIFEo
-J: AUIOS O{LY
coirarNEo STNGLE LrMr-r
lEa acod6.rj
EOOTLY INJUFY (P!r !e.son)
ts UMABELLALIAB
ErcEss uAa
occua
CLAJMS-MADE
oeo X nerenror r ,n n*
X X cuP5c928s70 $2 000.000
AGGFE6AIE
s
113112025' 1/312026 EACHoccUaBENcE
t2 000.000
woa(EBscoirPEtis ltor{
A'tD €IIPLOYEFS' LIABILITY
ANYPFOPF]ETON;PAFTiIEFI]EXECUTIVE
OFFICERMEMEEBEXCLUOEO?(t|.nd.rory ln NH)
u89J775605c 1t31t2025 1t31DO26 x
E ! OISEASE , POL CY IIM]T ! 1.000 000
UTE
E ! OTSEAS€ EA EMPtOYEEi t 1 000.000
F.!..FJg! 499!P-E]LL_t 1 000,000
PROVAE000020900
A99le9ato
1131nO25 1131D026 Pc( atnn 5 000 000
5.000.000
o€ScnlPnota oF oPEEAnOtEt / LoCATTol{g , VEslCLEti IAGOAO 101, A(Elrlor!.r 8rrBlt. S.trduL, nt y b. ir.h.d Il rnor. !Fc! fi r.qul.d)
Rc: RFP 9445 Architgctural & Engin..nng Seturc6s On-Call
CERTIFICATE HOLDER CANCELLATION
City of Fort Collins
P.O. Box 580
Fort Collins CO 80522
USA
SIEULD ANY OF THE ABOVE DESCAIBED POUCIES AE CAI{CELLED BEFOFE
THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVEFED IN
ACCOPDANCE WTHTHEPOLICY PBOVISIONS.
AIIITIOFIZED FEPBE}ETTATryE
16.^r UrP,t+
L/
@ 1988-2015 ACORD CORPOFAION. Allrighl! r!!€wed,
The ACORD neme and logo are reglstered marks ol ACORDACORD 2s (2016/03)
1O4A1 2 ' ol2
Y/tr
COVERAGES
CERTIFICATE OF LIABILIry INSURANCE 1t21
THIS CERTIFICATE IS ISSUED AS A iIATTER OF INFORITiATION ONLY AND CONFERS NO RJGHTS UPON THE CERTIFICATE HOLDER. T}IIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AiIiENO, EXTET'IO OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
8ELOW. TH|S CERTTFTCATE OF TNSURANCE OOES NOT CONSTTTUTE A CONTRACT BETWEEN THE |SSU|NG TNSURER(S), AUTHORTZED
REPRESENTATIVE OR PROOUCER, ANO THE CERTIFICATE HOLDER
IMPORTANT: lf tho cortificato holder b an ADOITIONAL lt{SUREO, the policy(los) must havo ADDITIONAL INSURED provisions or be ondorsod.
It SUBROGATION lS WAIVED, Bubiect to the toms and conditions of tho policy, cefiain policies may roquine an endorsemenl A statsmenl on
thra cedificate does not conto. rights to the cenificato holdor in li6u of such ondorsomont{s).
Risk Strateoies
12801 Norttr Central Exov. Suite 1 725
Dallas, TX 75243
Joe Bryanl
14 323 4602 14 503-8899
RS uesl sk-slra
INSURER(S) AFFORDING COVERAGE
TNSURERA: AXIS Surplus lnsurance Company 26620
INSUREO
Huitt-Zollars, lnc.
5430 LBJ Freewav
Surte '1500
Dallas TX 75240
INSI]RER B
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEO EELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOO
INOICATED NOTWTHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER OOCUMENT WTH RESPECT TO WT1ICH THIS
CERTIFICAIE MAY 8E ISSUEO OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIEED HEREIN IS SUBJECT TO ALL THE TERMS
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHO\^A MAY HAVE BEEN REDUCED BY PAID CLAIMS.
AOOL SlJBR
COM ERCIALGENERALLIAAILITY
GEN'L AGGREGATE LIMLT APPLIES PER:
JECT LOC
PREMISES (Ea @curen@)
MED EXP lAny one pe6on)s
PERSONAL&AOVINJURY
GENERALAGGREGATE
PRODUCTS. COMP/OP AGG
s
AllTOtilOBlLE llABlLlTY
AUTOSONLY
HIREO
AUTOSONLY
SCHEOULEO
AUIOS
NON OWNEO
AIJTOSONLY
COMBlNEOSINGLE LIMIT s
BOoILY INJURY (P6r pe6o.)
soorLY TNJURY (Per aGid6^r)
s
s
EXCESSLIAB
OCCUR 5
AGGREGATE s
OED RE-IENI ON S s
WORKERSCOMPENSATION
ANO EIPLOYERS'UABILIIY
ANYPROPRIETOR/PARTNER/EXECUTIVE
OaFICER \TEMBEREXCLLIoEO?
DESCRIPTTON OF OPERATIONS b6l@
E L. EACB ACC DENT s
E L OISEASE EA EMPLOYEE s
E L DISE^SE POLICY L MIT s
Pro€ssional Liability
Pollution Laability
E82665006i01i2025 1t23t2025 1t2312026 Per Claim
Annual Aggregate
$1,000,000
s1,000,000
DESCR| pnON OF OPERATION S / LOCATI ONS / VEHICLES (ACORD 101, Addirionel R.h.rtc S.h.dul., m.y bo rnachod it froG 3pace i3 6quicd )
The claims made pro€ssional liability co\erage is the total aggregate limit 6r all dairns presented within he annual policy period and is
subject to a deductible.
RE: Project M: R304965.01 - North Colleoe Fedestdan Gap Projecl
CERTIFICATE NUMBER:REVISION NUMBER:
CANCELLATION
O 1988-2015 ACORD CORPORATION. All rights ressrved.
Th€ ACORD nam€ and logo ar€ rEgislErqd marks of ACORD
:ra.iei-e Br.ld l/21/2025 9:05:33 r,r.i tES: Paq€ r of i
Citv of Fort Collins
281 North Colleoe Avenue
Fort Collins CO -80522
SHOULD ANY OF THE AAOVE DESCRIBEO POLICIES BE CANCELLEO BEFORE
THE EXPIRATION OATE THEREOF, NOTICE WILL BE OELIVEREO IN
ACCORDANCE WITH TItE POLICY PROVISIONS,
AIII}IORIZED REPRESENTANVE
fta a7*-
Joe Bryant
CERTIFICATE HOLDER
ACORD 25 (2016/03)
,q<:<>pif
I
I
t
Yrn| | |El",^l I
I
,q,<:<>ri:.CERTIFICATE OF LIABILITY INSURANCE 1t22t2025
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 OOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: lf the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
lf SUBROGATION lS WAIVED, subiect lo lhe terms and conditions of the policy, certain policies may require an endorsemenl. A statement on
this ceiificate does not confer rights to the certillcate holder in lieu of such endorsement(s).
Higginbotham lnsurance Agency, lnc.
225 Union Blvd, Ste 575
Lakewood CO 80228
Nate Lovekamp
PHONE 720{95-3376 720-695-3376
nlovekam inbolham.com
INSURER(S) AFFORDING COVERAGE
rNsuRER A: Prnnacol Assurance 411S0
INSUREO
Colorado Sign LLC
1005 Alkire Street
Golden CO 8040'1
THECOLO43 rNsuRER B I Seleclive lnsurance Companv Of South Carolina 19259
INSURER E
COVERAGES CERTIFICATE NUMBER: 1206s01 40 REVISION NUMBER:
THIS IS TO CERTIF/ THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOO
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERIU OR CONDITION OF ANY CONTRACT OR OTF]ER DOCUI\,{ENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDEO BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REOUCED BY PAID CLAI|t,lS.
INSR ADDL
x COMMERCIAL GENERAL LIABILITY
CLAIMS NIADE
GENL AGGREGATE LIMIT APPLIES PER:
X
"o,", [ !l"g !.o"
s 2505363 31612025 31612A26 51,000 000
OAMAGE TO RENTEO
PREM SES aE. tr.Liren.er s500,000
MED ExP (Anv one pe6on)s 15 000
PERSONAL & AOV IN,]LJRY s 1 000 000
GENERAL AGGREGAIE s 3,000 000
PROD UCIS , COM P]OP AGG s3,000 000
5
E AUiOMOBILE LIABILITY
OWNEO
H REO
AUTOS ONLY
SCHEDLJLED
AUTOS
NON'OWNEO
AI]TOS ONLYXx
316'2025 31612A26 COMBINED SINGLE LIM T 5 T,000 000
BOOILY NJURY (Per pe6on)
BOOILY INJLJRY (Per acctenl)5
S
S
X
EXCESS LIAB
x OCCUR
CLAIMS-MAOE
s 2505363 31612025 31612026 EACI] OCCURRENCE 51.000 000
s 1.000 000
RETENTION S s
WORKERS COIIPENSATION
ANO Ef PLOYERS' LIAEILITY
ANYPROPRIETOFYPARTNER]EXECUTIVE
OFFICER/MEMBER EXCLUDED?
I
PTION OF OPERAfoN-S bele*_
4245359 71112024 STATI]TE
)TH.
E L EACH ACCIDENT $ 1000,000
E,L. OISEASE. EA EMPLOYEE $ 1000,000
E L DISEASE, POLICY L MIT s 1000,000
DEscRtpTlON OF OPERATIONS / LOcATtoNs / VEHICLES (ACORO 101 . Additional R.nark. Schodutr, m.y be .n ch.d if hore .paco is r.qut.d)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE OELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
RESENTATIVEAIITHORIZEO
crtv of Fort collins
28i N. cotlege Ave
Fort ColIns CO 80524
O 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03)The AcORD name and logo are registered marks of ACoRD
tr
s 2505363
Y/Nl I IEl*,^l Ittt
711t2025 x
.-l.ACORD"SELEBUI.O2
CERTIFICATE OF LIABILITY INSURANCE DATE (I{M/DD/YYYY)
1t2212025
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYANO CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS
CERTIFICATE OOES 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), AUTHORIZEO
REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE HOLDER.
IMPORTANT; It tho c.rtificat6 holder is an AOOITIONAL INSURED, the policy(ios) must have ADDITIONAL INSURED provisions or bo endorssd.
lf SUBROGATION lS WAIVED, subiect to tho torms and conditions ofthe policy, certain policies may roquiro an endorsement. A stalemont on
this certificate does not confer rights to tho cortiticate holder in lieu of such 6ndorsement(s).
PRODUCER
Mounlaln West lnsurance - Englewood
3575 S Sherman Street
Englewood, CO 80'113
fiR [lcr Tricia eui
li3lfi. .,u, (gog) ssr-4see |ff. n.r,(303) 762-1733
tricia t,com
INSURER(S) AFFORDING COVERAGE
TNSURERA: EmDlove/s Mutual Casuahv Comoanv 21415
INSURED
Select Bullding Group Commerclal, LLC
Y54 Havana St. Unit B
Denver, CO 80239
tNsuRER s : Landmark American lnsurance 33138
tNsuRER C : Pinnacol Assurance 41190
rNsuRER o: Columbia Casualtv ComDany 31127
INSURER E
COVERAGES c ATE NUMBER:RE NUMBER:
THIS IS TO CERIIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEO TO THE INSURED NAMEO ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER OOCUMENT 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 EEEN REOUCED BY PAIO CLAIIVS.
TYPE OF INSURANCE POLICY EFF LIMITS
EACIi OCCURRENCE
't,000,000
$
OAMAGE TO RENTED 50,000$
MEO EXP aAnv one oe6on)10,000$
PERSONAL A ADV INJURY 1,000,000s
GENERAL AG6REGATE 2,000,0005
PROOUCTS. COMP/OP AGG 2,000,000$
A COITMERCIAL GENERAL LIABILI
x
x
GEN'L AGGREGATE
THER
LOC
LI[,tIT APPLIES
,ECT I I
't0t1t2024 10t112025
$
COMBINED SINGLE LIMII 1,000,000$
PROPERTY OAMAGE
S
A
NONOWNEO
AUTOS ONLY
AIJTOMOBILE LIABILITY
X llffoo" o^."
SCHEOULED
AUTOS
OWNEO
AUTOS ONLY
6X48646 1011t2024 't01112025
i
x EACH OCCURRENCE 5,000,000SOCCUR
CLA'!,ISJ\,iAOEx
Ul.ARELLA L|AA
EICESS LI,AB AG6REGATE 5,000,000$
B
DEO RETENTION $
1HA602993 '1011t2024 10t112025
$
x OTH.
E L EACHACCIDENT 1,000,000$
E,L DISEASE. EA EMPLOYEE
'1,000,000
$
WORKERS COMPENSATION
AND EMPIOYERS' LIABILITY
ANY PROPRIETOR/PAFTNERiEXECUIIVE
OFFICER/MEMBER E^CLUDED?
DE$RIPTION OF OPERATIONS below
N
Y/N
c
N
21112026
1,000,000
42'14877 211!2025
E,L, DISEASE. POLlcY LIMIT
D Professional cPB591943253 10t1t2024 10t112025 2,000,000
DESCRIPTION OF OPERATIONS / LOCATIICNS / VEH ICLES (ACORD 101, Addltlonal R€h.rk3 Sch.duL, may b. attached if m@ space ls raqulr.d)
c
O 1988-2015 ACORD CoRPORATION. All rights reserved'
SHOULD ANY OF THE ASOVE DESCRIBED POLICES BE CAI{CELLEO AEFORE
THE EXPIRATION OATE THEREOF, NOTICE WLL BE DELIVERED IN
ACCOROANCE WITH THE POLICY PROVISONS.
AUTHORZED REPRESENTATIVE
City o, Fort Collins
281 N College Ave.
Fort Collins, CO 80524
ACORD 25 (2016103)
The ACORD name and logo are registered marks ol ACORD
lil lIl:
6X48646CLATMS-MAoE I X I occun
oiQo'CERTIFICATE OF LIABILITY INSURANCE
COVERAGES CERTTFTCATE NUMBER: Masrer 25i 26 REVISION NUMBER:
0111712025
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE OOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTENO 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: lf the certificate holder is an ADDITIONAL INSURED , the policylies) must have AOOITIONAL INSURED provisions or be endorsed
lI SUBROGATION lS WAIVED, subject to the terms and conditions of the policy, certain policies may requhe an endorcement. A statement on
this certilicate does not conrer rights to the certificale holder in lieu of such endorcement(s).
CoWesl lnsurance Services. LLC
PO. Box 910
Castle Rock co 80104
Grinder Group lns
(303)688-9597 (303)688-8858
INSURER(S) AFFORDING COVERAGE
tNsuRERA. Fireman's 21784
INSURED
SuperiorTraffc & Restoration SeNices LLC
6500 Franklin St Unil C and O
Denver co 80229
tlsURER B. Fireman's 21784
tnsuRERc. Pinnacol Assura nce 41190
rNsuRERD. Ma*eYEvanston
THIS IS TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTEO BELOW HAVE BEEN ISSUEDTOTHE INSIJRED NAMEDABOVE FOR THE POLICY PERIOO
INOICATED NOTWTHSTANOING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO VVTIICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDEO BYTHE POLICIES OESCRIBEO HEREIN IS SUAJECT TO ATL THE TERMS,
EXCLUSIONS ANO CONOITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REOUCED BY PAIO CLAIMS
GEN'LAGGREGATE L M TAPPLIES PER:
JECT LOC
cPA3272615 -23 011o6t2026
EACI] OCCURRENCE $ 1,000,000
$ 300,000
MED ExP lAnv one Deconl $ 10,000
PERSONAL & ADV INJI-]RY $ 1,000,000
6ENE RAL AGGREGATE $ 2,000,000
PRODUCTS. COMP/OPAGG $ 2,000,000
5
AUTOMOBILE LIABIL TY
HIREO
SCHEDULED
NON.O\ryNED
cP43272615 23 a110612025 41146t2026
COMBINED SINGLE LIMIT $ 1.000,000
BOOILY INJURY (Pdpe66)
aOOILYINJURY (Per&cident)
s
Uninsured motorist 8l-$ 1,000,000
B
x
EXCESS LIAB
x
CLAIMS.MAOE cPA3272615.23 41to612025 4114612026
$ 1,000,000
$ 1,000,000
oEo RETENTION S 5
C
YgORKERS COMPEI{SATION
AND EMPLOYERS' TIABITITY
ANY PROPRIEIOR/PARTNEIVEXECIJTIVE
OFFICER/MEMBER EXCLUOEO?
OESCRIPTION OF OPERATIONS bel
4221935 01t01t2025 0110112026
xl 35^B,,,. I
OTH-
E.L. EACHACCIDENT $ 1,000,000
EL CI:]fASf EA EI.IPLCYEE s 1,000,000
E.L DISEASE- POL CY LIIiIT s 1,000,000
D
Excess Liabl[y
MKLV4EUElOl OS3 01to6t2a25 01t0612026
Aggregale 4.000,000
DESCRIPTIOIi OF OPERATIOIIS / tOCAnOnS /VEHICLES {ACORO 101. Addlton.l Ren.rtr Schedule, nry b€ afiach€d ifnor..p&.13 r.qulr.d)
City of Fon Collins is additionalinsured as per wrillen contlact.
CERTIFICATE HOLDER CANCELLATION
CU of Fort Collins
280 N College Ave
co 80524
SHOULO ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION OATE THEREOF, NOTTCE wlLL BE OELIVERED IN
ACCORDANCE WTH THE POLICY PROVISIONS,
AUTHORIZED REPRESENTATIVE
ACORO 25 (2016/03)
O 198&2015ACORO CORPORATIOi{. All rights reserved
The ACORD n.me and logo are registered marks otACORD
] "ro'r.-roo. ffi o""r"
4114612025
Forl Collins
I