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HomeMy WebLinkAboutLARIMER HUMANE SOCIETY - INSURANCE CERTIFICATEACORDM CERTIFICATE OF LIABILITY INSURANCE DATE (MM1DDNYYY 1 06/05/2007) PRODUCER (303)776-5122 FAX (303)776-5495 First Mai nStreet Insurance 512 4th Avenue P.O. Box 847 Longmont, CO 80502 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Larimer Humane Society PO Box 272450 Fort Collins, CO 80525 INSURERA: Great American Insurance Co. INSURERS: Pinnacol Assurance INSURER C: INSURER D: INSURER E: CnVFRAnFR 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. INSR ADUL TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE IMWDDIYYI POLICY EXPIRATION DATE [MM1DDrYY) LIMITS GENERAL LIABILITY PAC5373770 05/01/2007 05/01/2008 EACH OCCURRENCE $ 1,000,00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED EA $PREMISES 100,000 CLAIMS MADE a OCCUR MED EXP (Any one person) $ 10,000 A PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 rlPOLICY 7 PROJECT 7 LOC AUTOMOBILE LIABILITY ANY AUTO CAP5373771 05/01/2007 05/01/2008 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ A ALL OWNED AUTOS SCHEDULEDAUTOS HIREDAUTOS NON-OWNEDAUTOS 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 UMB5373772 05/01/2007 05/01/2008 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,000 A $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND 4015370 07/01/2007 07/01/2008 X WC STATU- I OTH- B EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 100,000 OFFICERIMF.MBER EXCLUDED? If yes, describe under E.L. DISEASE - EA EMPLOYEE — $ 100,000 E.L. DISEASE. POLICY LIMIT — $ 500,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS ertificate Holder as Additional Insured as required by written contract per policy form. City of Fort Collins Purchasing Department Attn: James O'Neil PO Box 580 Fort Collins, CO 80522 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 MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INS AUTHORIZED REPRESENTATIVE ITS AGENTS OR REPRESENTATIVES. Deaver AGURD 25 (ZUUI/U8) rAA: I,y�u�cc4-b134 ©ACORD CORPORATION 1988 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. ACORD 25 (2001/08)