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Home My WebLink AboutCITY OF FORT COLLINS - INSURANCE CERTIFICATE (2)ACORJ. CERTIFICATE OF LIABILITY INSURANCE I 5/2S/ 006 PRODUCER (303) 773-9999 FAX (303) 773-9776 Arthur J. Gallagher Risk Management Services, Inc. 6399 S. Fiddlers Green Circle Suite 200 Greenwood Village, CO 80111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAT N ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND ALTER THE COVERAGE AFFORDED BY THE POLICIES BEL W. INSURERS AFFORDING COVERAGE NAIC # INSURED City of Fort Collins P.O. Box 580 Fort Collins, CO 80522 INSURERA: Princeton E&S INSURERS: Midwest Employers Casualty Co INSURERC: Lexington Insurance Company INSURER D: INSURER E t_nVFRARFC THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHST DING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED O MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF UCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY OIA3RL000004700 05/1S/2006 04/1S/2007 EACH OCCURRENCE $ 500,000 )( COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PRFMMED ,EXP f CLAIMS MADE occuR COV A -GENERAL LIAB (My one versa,) $ A X X SIR 5500,000 Per AUTO LIAB., LEL LIAB. PERSONAL dADVINJURY f OV B-PUBLIC OFFICIALS Occurrence GENERAL AGGREGATE $ S 0,00 LIABILITY GENL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG S X POLICY E T LOC AUTOMOBILE LIABILITY OIA3RL000004700 OS/15/2006 04/1S/2007 COMBINED SINGLE LIMIT X ANY AUTO (Ea soddent) j IN LUDE ALL OWNED AUTOS BODILY INJURY f A X SCHEDULED AUTOS (p. Pe.) I BODILY INJURY j HIRED AUTOS NON -OWNED AUTOS (Per accident) G ERA PROPERTY DAMAGE f (Per aodden t) LIARILITY GARAGE LIABILITY AUTO ONLY - EA ACCIDENT f OTHER THAN EA ACC $ ANY AUTO f' AUTO ONLY:11 AGG EXCESS/UMSRELLALIABILITY 01A3RL000004700 04/15/2006 04/1S/2007 EACH OCCURRENCE $ 2.SOO.000 X OCCUR CLAIMS MADE AGGREGATE $ 5 , SO , O A X j j DEDUCTIBLE RETENTION $- WORKERSCOMPENSATION AND EWC00S901 (SIR $400,000) 04/1S/2006 04/15/2007 X I wCSTATU- oTH- TORY LIMITS EMPLOYERS' LIABILITY (MDE#7S39 SIR $ 7 SO , 000 E.L. EACH ACCIDENT $ 1, OO , 00 B ANY PROPRIETORIPARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYE $ 1, 00 , OO OFFICER/MEMBER EXCLUDED7 If yes describe under SPECIAL PROVISIONS below E.L. DISEASE - POUCY LIMIT f 1 0 00 RDIRTY CVG-SPECIAL 87S4913 04/1S/2006 04/1S/2007 PER OCCURRENCE:S100,000, 00 C pRM, BWKT BLDG & POLICY DEDUCTIBLE 550,0 O ERS PROP VEHICLE DEDUCTIBLE $100, 00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHWA ES EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS e: Any and all contracts. Burlington Northern and Santa Fe Railway CO & Staubach Global Services - kR fisted as Additional Insureds as respects General Liability/Auto Liab. Burlington Northern and Santo e Railway CO listed as Loss Payee as respects Property. Waiver of Subrogation applies as equired by written contract. General Liability is primary and non-contributory to the holder's nsurance coverage. See attached notes. r,F:PTIRICATF Hnl nFR I`Akld`=I I ATlnwl Burlington Northern and Santa Fe Railway SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Company EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL IWBiX► M MAIL Staubach Global Services 30 DAYS WRITTEN NOTICE TO THE CERTWICATE HOLDER NAMED TO THE LE , 56SO North Riverside Drive Suite 101 NKXdiaXD KKK XXX Fort Worth, TX 76137 AUTHORIZED REPRESENTATIVE Karen Graham H--- ACORD 25 (2001108) OACORD 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. AGORD 25 (2001/08) Additional Coverages and Factors 05/25/2006 Line of Business Coverages for General Liability Coverage Limits Ded/Ded Type Rate Premium Factor General Aggregate 500,000 Each Occurrence 500,000 500,000 Line of Business Coverages for Workers Compensation Coverage Limits Ded/Ded Type Rate Premium Factor WC & Employer's liability 1,000,000/1,000,000/ 400,000 11000,000 Burlington Northern and Santa Fe Railway Certificate issued to Burlington Northern and Santa Fe Railway 05/25/2006 Arthur J. Gallagher Risk Management Services, Inc. 05/25/2006 Railroad Exlusion for work performed within 50 feet of a railroad has been deleted. For any and all contracts.