HomeMy WebLinkAbout- - (23) A CERTIFICATE OF LIABILITY INSURANCE OAT06/04//2O 5YYY)
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).
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PRODUCER CONTACT .�
NAME:
Aon Risk Services South, Inc. PHONE (866) 283-7122 FAX (800) 363-0105 y
Charlotte NC office (A/C.No.Ext): (aC.No.):
v
MSC# 17693 EMAIL C
PO Box 551343 ADDRESS: _
Atlanta GA 30355 USA INSURER(S)AFFORDING COVERAGE NAIC#
INSURED INSURER A: Beazley Excess and Surplus insurance Inc 17520
RTI international INSURERB; American Casualty Co. Of Reading PA 20427
3040 Cornwallis Rd
PO Box 12194 -INSURER C: AIU Insurance Company 19399
Research Triangle Park INC 27709-2194 USA INSURERD:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 570113028782 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. Limits shown are as requested
lNSH LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYY MM/DD/YYYY LIMITS
13 X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000
CLAIMS-MADE X❑OCCUR PREMISES Ea occurrence $1,000,000
MED EXP(Any one person) $15,000
PERSONAL&ADV INJURY $1,000,000 -
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000 000 m
POLICY ❑PRO- ❑X LOC PRODUCTS-COMP/OP AGG $2,000,000 co
OTHER:
0
B AUTOMOBILE LIABILITY 4034978456 06/01/2025 06/01/2026 COMBINED SINGLE LIMIT LO
$1,000,000
Ea accident
ANY AUTO BODILY INJURY(Per person) Z
OWNED SCHEDULED BODILY INJURY(Per accident) y
AUTOS ONLY AUTOS
HIREDAUTOS NON-OWNED PROPERTYDAMAGE V
ONLY AUTOS ONLY Per accident
X $1,000 Coll Ded X $1,000 Comp Ded r
N
UMBRELLA LIAB OCCUR EACH OCCURRENCE fJ
EXCESS LAB CLAIMS-MADE AGGREGATE
DED I RETENTION
C WORKERS COMPENSATION AND 020396116 06 O1 202 5 06/01/2026 X I PER STATUTE ORTH-
EMPLOYERS'LIABILITY Y/N ADS
ANY PROPRIETOR/PARTNER/EXECUTIVE
C OFFICER/MEMBEREXCLUDED? � N/A 020396118 06/01/2025 06/01/2026 E.L.EACHAccIDENT $1,000,000
(Mandatory in NH) wi E.L.DISEASE-EA EMPLOYEE S1,000,000
If Yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S1,000,000_-
A E&O - Miscellaneous —T-D1B95B251001 06/01/2025 06/01/2026 Each Claim 11000,000
Professional-Primary Cyber claims Made Aggregate Limit $1,000,000
SIR applies per policy terns & condi ions
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
The City of Fort Collins, its officers, agents and employees are included as Additional insured in accordance with the policy
provisions of the General Liability and Automobile Liability policies.
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.
The City of Fort Collins, CO AUTHORIZED REPRESENTATIVE
Attn: Purchasing Department
PO Box 580
Fort Collins Co 80522 USA V OW e9f�liw 6J �
01988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD