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AFRO® CERTIFICATE OF LIABILITY INSURANCE FEIMMI DN
025
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).
PRODUCERCONTACT
NAME_ Terri Wroblewski
CRS Insurance Brokerage PHONE_-- - - _. z._---- -- -
9780 S Meridian Blvd Suite 400 • 303-996-7800 aC No:303 757-7719
IL
Englewood CO 80112 ADDRESS: twroblewskj@crsdenver.com
INSURERS AFFORDING COVERAGE j NAIC_N
INSURERA: United Specialty Insurance Co 12537
INSURED SUMMSEA-01
INsuRERe: Horizon Midwest Casualty Com anir___ 14401
Summit Sealants, Inc,
dba. Summit Sealants and Restoration Services, Inc. INSURER c: Indian Harbor Insurance 36940
2450 N. Townsend Avenue iNSURERD,_Middlesex Insurance Company 21-
Montrose CO 81401 INSURER E: Endurance Amercian Specialty 41716
INSURER F:
COVERAGES CERTIFICATE NUMBER:1116409 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.
ILT R TYPE OF INSURANCE AODL SUBRI 'POLICY EFF -POLICY EXP_1_
LTR ! N WV POLICY NUMBER MMlDD YYYY MMlDD/YYY ' LIMITS
A X ! COMMERCIAL GENERAL LIABILITY ATN25611030 6/1/2025 6/1/2026 i EACH OCCURRENCE $1,000,000
--
DAMAGETO ENTE6
CLAIMS-MADE ! X OCCUR I PREMISES IEa occurrenPM_ $100,000 _ -
___ f I MED EXP(Any one person) $10,000
PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 52,000,000
POLICY! X PRO•
L JE CT LOC PRODUCTS-COMP/OPAGG $2,000,000
�
OTHER: $
D AUTOMOBILE LIABILITY A0251301 6/1/2025 6/1/2026 COMBINED SINGLE LIMIT $1,000,000
i
X j ANY AUTO BODILY INJURY(Per person) S
OWNED SCHEDULED !AUTOS ONLY AUTOS BODILY INJURY(.Por accident) S
i _ _
HIRED NON-OWNED PROPERTY DAMAGE—_
AUTOS ONLY AUTOS ONLY _(Per accident)_
S
A UMBRELLA LIAB X OCCUR BTN2522889 i 6/1/2025 i 6l1/2026 1 EACH OCCURRENCE $5.000,000
X EXCESS LIAB �—
_____ ,__i__CLAIMS-MADE AGGREGATE $5,000,000
1------------- -
DED I X I RETENTIONS
g WORKERS COMPENSATION S
WC300-0006648-2025A 6/1/2025 1 6/1/2026 iX TATUTE ERH _
AND EMPLOYERS'LIABILITY —
!ANYPROPRIETOR/PARTNER/EXECUTIVE YIN I E.L,EACH ACCIDENT
OFFICER/MEMBEREXCLUDED9 IN/A $1,_0 00,000
_
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
II yes,describe under I r -------- —--
DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $1,000,000
p !Installation Floater -- -
C InsPoltall ti Liability A02M301 ? 6/1/2025 i 6/1l2026 Limit �{50,000-
E Excess Layer Liability PEC006596601 6/1/2025 j 6/1/2026 j agg Oolou oendtelon 34M/34M ELD30064533001 6/l/2025 6/1/2026
I i i
DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached It more space Is required)
City of Fort Collins is included as additional insured for ongoing operations on the General Liability and included as additional insured on the Auto Liability with
respect to operations of the named insured for the certificate holder 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.
PO Box 580 Fort Collins CO 80522 AUTHORIZED REPRESENTATIVE
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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