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HomeMy WebLinkAboutBlanco, Inc. - Insurance Certificate 2023-2024 ®A�� DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 08/01/2023 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 endorsement(s). PRODUCER CONTACT Moody Insurance Agency,Inc. NAME: Moody Insurance Agency,Inc. aICONN Ext: (303)824-6600 AX No): (303)370-0118 8055 East Tufts Avenue E-MAIL certrequest@moodyins.com ADDRESS: Suite 1000 INSURER(S)AFFORDING COVERAGE NAIC# Denver CO 80237 INSURERA: Selective Insurance Co of America 12572 INSURED INSURER B: Plnnacol Assurance 41190 Blanco, Inc.&JL&D Investments INSURER C: 796 Poppy Dr. INSURER D: INSURER E: Brighton CO 80601-3353 INSURER F: COVERAGES CERTIFICATE NUMBER: 23.24 Master 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. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGEN CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ 500,000 MED EXP(Any one person) $ 15,000 A Y S250690700 08/01/2023 08/01/2024 PERSONAL&ADV INJURY $ 1,000,000 RTHER. AGGREGATELIMITAPPLIESPER. GENERAL AGGREGATE $ 2,000,000 OLICY PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 JECT Limited Pollution Liability $ 100,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED S250690700 08/01/2023 08/01/2024 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LAB CLAIMS-MADE S250690700 08/01/2023 08/01/2024 AGGREGATE $ 2,000,000 DED I X1 RETENTION $ 0 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? NIA 4107463 08/01/2023 08/01/2024 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Leased/Rented Equipment A S250690700 08/01/2023 =iimit $350,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:City of Fort Collins is included as an Additional Insured with respect to General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. 281 N.College Avenue AUTHORIZED REPRESENTATIVE Fort Collins CO 80524 mowq �ft tv ca_- @ 1988988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 00017498 LOC#: ACORO® ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED Moody Insurance Agency,Inc. Blanco,Inc.&JL&D Investments POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance:Notes General Liability CG 73 00 06 22—Blanket Additional Insured,Additional Insureds Primary Non-Contributory Provision,Blanket Waiver of Subrogation Status When Required by Written Contract CG 79 88 06 22-Blanket Additional Insured,Ongoing Operations&Completed Operations when required by Written Contract Automobile Liability CA 78 16 04 23 -Blanket Additional Insured Status&Blanket Waiver of Subrogation Status When Required by Written Contract Workers Compensation 359-B-Blanket Waiver of Subrogation status applies when required by written contract. Umbrella Liability is on a follow form basis for underlying insurance coverages: General Liability,Automobile Liability,and Employers Liability. Additional Insured Status will Follow When Required by Written Contract,including for Primary Non-Contributory Status. **Please Note Hard Copies of Endorsements will not be sent vial mail. All Endorsements will only be sent electronically via email. Please send your email address to certrequest@moodyins.com for forms and future mailings. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD