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HomeMy WebLinkAboutPOST BUCKLEY SCHUH JERNIGAN PBS J - INSURANCE CERTIFICATE (6)1C�ORD,M CERTIFICATE OF LIABILITY INSURANCE 10/02/2 0 ' PRODU ER (305)822-7800 FAX 305827OS8S THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Collinsworth, Alter, Fowler, Dowling ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR & French Group Inc. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. 0. Box 9315 Miami Lakes, FL 33014-9315 INSURERS AFFORDING COVERAGE NAIC # INSURED Post, Buckley, Schuh, & Jernigan, Inc. INSURERA: Sentry Insurance a Mutual Company A+ XV d/b/a PBS&J INSURERS: Steadfast Insurance Company A XV 2001 NW 107 Avenue INSURERC: Lloyds of London A XV Miami, FL 33172-2507 INSURER D: INSURER E: QnVERAf--='t 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 ADIYL TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MWDD/YYI POLICY EXPIRATION DATE fMM/DnfYYI LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE O OCCUR X Contractual Liab 90-15807-03 09/30/2004 09/30/2005 EACH OCCURRENCE $ 1,000 00 DAMAGE TO RENTED PRFRAIRFS IF, $ 1,000,00( MED FXP (Any one person) $ 25.00 PERSONAL & ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,000,00( GENT AGGREGATE LIMIT APPLIES PER: POLICY X JECT X LOC PRODUCTS - COMP/OP AGG $ 2,000,00( A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON-OWNEDAUTOS Contractual Liab 90-15907-04 90-15807-05 09/30/2004 09/30/2005 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY -EA ACCIDENT S OTHER THAN EA ACC AUTO ONLY: AGG S $ B EXCESSIUMBRELLA LIABILITY X OCCUR CLAIMS MADE DEDUCTIBLE X RETENTION $ 10,00 AUCS08762100 09/30/2004 09/30/200S EACH OCCURRENCE S 25,000 00 AGGREGATE $ 25,000,000 $ $ $ A WORKERS COMPENSATION AND EMPLOYERS'LUABILMY ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below S 90-15807-01 90-15807-02 NO 09/30/2004 09/30/200S X WC STATU- OTH- E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,00 C OTH roYe'ssional/ Pollution Liability P42304 CLAIMS -MADE FORM 09/30/2004 09/30/200S $1,000,000 Limits Ea Claim and Annual Aggregate 11/11/1961 Retrodate DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS „w, M nwuno r wrr^u SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Fort Collins, City of 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Attn • Katy Carpenter/City Clerk BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY P.O. Box 580 OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 Meade Collinsworth EEC ACORD 25 (2001/08) ©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 (2001108)