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HomeMy WebLinkAbout- - (24) DATE(MWDD/YYYY) A o CERTIFICATE OF LIABILITY INSURANCE I 06/04/2025 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 p AOn Risk services south, Inc. NAME. FAX Charlotte NC Office (A/C.No.Ext): (866) 283-7122 (A C.No.): (800) 363-0105 MSC# 17693 ADDRESS: _ Po Box 551343 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 INSURERC: AIU Insurance Company 19399 Research Triangle Park NC 27709-2194 USA INSURERD: INSURER E: INSURER F: ,r,•, S 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MWDD/YYYY MM/DD/YYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 DAMAGE F0 RENTED CLAIMS-MADE X❑OCCUR PREMISES Ea occurrence $1,000,000 MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $1,000,000 NO GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 N POLICY PRO ❑X LOC PRODUCTS-COMP/OP AGG $2,000,000 M JECT OTHER: n e 40349784S6 06/01/2025 06/01/2026 COMBINED SINGLE LIMIT 1O AUTOMOBILE LIABILITY Eaccident) $1,000,000 ANY AUTO BODILY INJURY(Per person) Z OWNED SCHEDULED BODILY INJURY(Per accident) ! AUTOS ONLY AUTOS PROPERTY DAMAGE HIREDAUTOS NON-OWNED Per accident ONLY ;_- AUTOS ONLY IX $1,000 Coll Ded X +1,000 Comp Ded d UMBRELLALIAB HOCCUR EACH OCCURRENCE U EXCESS LIAB CLAIMS-MADE AGGREGATE DEDI IRETENTION C WORKERS COMPENSATION AND 020 96 1 06 01 0 5 06 01 2026 X I PER STATUTE ETRH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1,000,000 O OFFICERWEMBEREXCLUDED? a 020 N/A 20396118 06/Ol/2025 06/Ol/2026 (Mandatory in NH) WI E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $1,000,000— DYSCRIPTION OF OPERATIONS below — A E&O - Miscellaneous D1B95B251001 06/01/2025106/01/20261 Each Claim $1,000,000— Professional-Primary Cyber Claims Made Aggregate Limit $1,000,000 SIR applies per policy ter s & condi I ions DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe 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 f SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE u EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. C•'• SS The City Of Fort Collins, CO AUTHORIZED REPRESENTATIVE Attn: Purchasing Department ` 415� PO Box l l i Fort Collins CO 80522 USA ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD