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Home My WebLink About113109 WATERFORD CORPORATION - INSURANCE CERTIFICATE (9)si�ORD CERTIFICATE OF LIABILITY INSURANCE, OPID D DATE(MM/DDIYY) TER 1 04/07/04 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Brown & Brown Inc - Ft Collins ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 125 S Howes, 5th Floor HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P O Box 2226 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fort Collins CO 80522-2226 Phone:970-482-7747 Fax:970-484-4165 INSURERS AFFORDING COVERAGE Waterford Corporation Tom 404 N Link Lane Ft Collins CO 80524 COVERAGES INSURERA: Pinnacol Assurance INSURER B: INSURER C: INSURER D: INSURER E: 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 LTR TYPE OF INSURANCE POLICY NUMBER P LI FF T DATE MMIDD/YY POLICY EXPIRATION DATE MMIDDIYY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR EACH OCCURRENCE $ FIRE DAMAGE (Anyone fire) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ EXCESS LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ $ A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY 1373992 04/01/04 04/01/05 X TORY LIMITS ER E.L. EACH ACCIDENT $100,000 E.L. DISEASE - EA EMPLOYEE $100,000 E.L. DISEASE -POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS FTCPURC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL -I-Q-- DAYS WRITTEN City of Fort Collins NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Purchasing Department 215 N Mason IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Fort Collins CO 80522 REPRESENTATIVES. ACORD 25S (7/97) nncnRn cnRPnReTInM 1QAR ACO17D CERTIFICATE OF LIABILITY INSURANCE TM. DATJU 2304' PRODUCER AFFINITY INSURANCE PARTNERS LLC 19201 E. MAIN STREET, SUITE # 203 PARKER CO 80134 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. PHONE: 303-841-0663 FAX: 303-840-3652 Agency Lie#: RPA00081754 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA: Auto -Owners Insurance WATERFORD CORPORATION 404 N LINK LANE FORT COLLINS CO 80522 INSURER B: INSURER C: INSURER D: INSURER E: 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 ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATELIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSI LT TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMID POLICY EXPIRATION DATE(MWDDfM LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE I_xl OCCUR A006232004GL JUN 23 04 JUN 23 05 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED $ 50,000 MED. EXP (Any One Person) $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRODUCTS-COMP/OP AGG. $ 2,000,000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNEDAUTOS A0062320046A JUN 23 04 JUN 23 05 COMBINED SINGLE LIMIT (Ea accident) $ 1,D00,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: A G $ $ A EXCESS I UMBERELLA LIABILITY X OCCUR CLAIMS MADE DEDUCTIBLE X RETENTION $ 10,000 A006242004UL JUN 23 04 JUN 23 05 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 0 $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTNE OFFICERNMMBER EXCLUDED? Iryn, describe under SPECIAL PROVISIONS below WC STATU- OTHER T iRY LIMITS E.L. EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ OTHER: DESCRIPTION OF OPERATIONS/LOCATION/VEHICLES/EXCLUSIONS ADDED ENDORSEMENT/ SPECIAL PROVISIONS CITY OF FORT COLLINS PURCHASING DIVISION FORT COLLINS, CO 80521 Attention: JOHN STEPHEN ACORD 25 (2001/081 Certificate # SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY 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 ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. 4475 REPRESENTATIVE `CQRD TM. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNY) I JUN 2304 PRODUCER AFFINITY INSURANCE PARTNERS LLC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 19201 E. MAIN STREET, SUITE # 203 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR PARKER CO 80134 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PHONE: 303-841-0663 FAX: 303-840-3652 Agency Licht: RPA00081754 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA: Auto -Owners Insurance INSURER B: WATERFORD CORPORATION 404 N LINK LANE FORT COLLINS CO 80522 INSURER C: INSURER D: INSURER E: 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 LT TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDDIYY POLICY EXPIRATION DATE NMIDDM! LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE I X OCCUR A006232004GL JUN 23 04 JUN 23 05 EACH OCCURRENCE $ 1,000,000 DDAMMAGE TO RENTEDPRE $ 50,000 MED. EXP (Any One Person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRODUCTS-COMP/OP AGG. $ 2,000,000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULEDAUTOS HIREDAUTOS NON -OWNED AUTOS A006232004BA JUN 23 04 JUN 23 05 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: A $ $ A EXCESS I UMBERELLA LIABILITY 4:1 OCCUR 1-7 CLAIMS MADE PDEDUCTIBLE X RETENTION $ 10,000 A006242004UL JUN 23 04 JUN 23 05 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 0 $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORMARTNERIEXECVTIVE OFFICERIM•MSER EXCLUDED? If yes, desedbe under SPECIAL PROVISIONS below WC STAT ITSI OTHER E.L. EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT 1 $ OTHER: DESCRIPTION OF OPERATIONS/LOCATION/VEHICLES/EXCLUSIONS ADDED ENDORSEMENT/ SPECIAL PROVISIONS CITY OF FORT COLLINS IS INCLUDED AS ADDITIONAL INSURED AS RESPECTS THE GENERAL LIABILITY POLICY. rFRTIFIrATF N[N n1:R I I ADDITIONAL INSURED: INSURER LETTER: rANr r-I I ATInN CITY OF FORT COLLINS DIRECTOR OF PURCHASING SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT PO BOX 580 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE FORT COLLINS, CO 80522 INSURER ITS AGENTS OR REPRESENTATIVES. Attention: AUTHORIZED REPRESENTATIVE �,��//I vV'' �� ACORD 25 (2001/08) Certificate # 4475 William R. Greer