HomeMy WebLinkAboutFOX LAWSON - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE 20 DATEI/04 YY
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PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
FBL Insurance Brokerage, LLC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
2627 KFB Plaza ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Manhattan KS 66505
Phone:785-587-6000 Fax:785-587-6886 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A. Colony Insurance Company
INSURER B: Houston Casulaty Company
Fox, Lawson & Associates, LLC INSURER C:
PO Box 32985 INSURER
Phoenix.AZ 85064
INSURER E:
1, V V CKA%j C5
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
L
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTR
DATE MWDD/YY
PDATE (MMIDDIYY N
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1, 000, 000
A
X COMMERCIAL GENERAL LIABILITY
CLAIMSMADE M OCCUR
GL3472345
12/15/06
12/15/07
PREMISES (Ea occurence)
$100,000
MED EXP(Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ EXCLUDED
GENERAL AGGREGATE
$ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ INCLUDED
X POLICY PECT RO LOC
J
AUTOMOBILE
LIABILITY
ANY AUTO
COM
Ea accident'INGLE LIMIT
sl 000,000
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per person)
$
A
HIRED AUTOS
NON -OWNED AUTOS
GL3472345
12/15/06
12/15/07
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
OTHER THAN EA ACC
$
$
AUTO ONLY: AGG
EXCESS/UMBRELLA LIABILITY
OCCUR CLAIMS MADE
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION $
$
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
-
TORY LIMITS ER
E. L EACH ACCIDENT
-
$
ANY PROPRIETOR/PARI NER/EXECU I IVE
OFFICERIMEMBER EXCLUDED?
E.L.DISEASE- EA EMPLOYEE
$
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
$
OTHER
B
Professional
Liability
H70617741
12/15/06
12/15/07
AGG/OCC $1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Hired and Non -Owned Coverage is Included in the General Liability policy.
The Certificate Holder is listed as an Additional Insured on the General
Liability policy only per Blanket A.I. endorsement (U156-0702).
City of Fort Collins
c/o James O'Neill II, CPPO
Director of Purchasing and Ris
PO Box 580
Fort Collins CO 80521
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANWIND UPON THE INSURER, ITS AGENTS OR
ACORD 25 (2001/08)
0
TION 1
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
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