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HomeMy WebLinkAboutBATH - INSURANCE CERTIFICATEClient#- 21043 RATIN ACORDTM CERTIFICATE OF LIABILITY INSURANCE (MMID 1DATE 0/26/0/26/O5D/YYYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Flood 8r Peterson Insurance Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4821 Wheaton Drive HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P O Box 270370 Fort Collins, CO 80527 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Zurich Bath, Inc. P. 0. Box 1966 Fort Collins, CO 80522 INSURER B: National Union Fire Insurance INsuRERc: Pinnacol Assurance INSURER D: INSURER E: COVERAGES 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 ADD' NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YY POLICY EXPIRATION DATE MMIDDNY LIMITS A GENERAL LIABILITY CP0369701303 11/01/05 11/01/06 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE Fx� OCCUR AMA PREMGE TO ES RE eTED n $300 000 MED EXP (Any one person) $1 Q 000 PERSONAL & ADV INJURY $1 000 000 X PD Ded:250 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 1-1 POLICY PRO- JECT LOC A AUTOMOBILE LIABILITY ANYAUTO CP0369701303 11/01/05 11/01/06 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X HIREDAUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ X X Drive Other Car PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG B EXCESSIUMBRELLA LIABILITY BE9035696 11/01/05 11/01/06 EACH OCCURRENCE s2000000 X OCCUR CLAIMS MADE AGGREGATE s2,000,000 $ DEDUCTIBLE $ X RETENTION $ 10000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE 4015110 11/01/05 11101/06 WCSTATU- OTH- X I MIT E.L. EACH ACCIDENT s500,000 E.L. DISEASE - EA EMPLOYEE $500,000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS City of Fort Collins c/o James O'Neill P.O. Box 580 Ft Collins , CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL In 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 AUTHORIZED REPRESENYTIVE Fl000( 'f Rt to f.00.j , ZkJC, AGUKU ZO (ZUUT/Ub) 1 of 2 #M329654 KLB 0 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. A%,UKu ca-a jzuuvuo/ 2 of 2 #M329654 ACORD,. CERTIFICATE OF LIABILITY INSURANCE 1DATE (MM/D 0/26/05DNYYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Flood & Peterson Insurance Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4521 Wheaton Drive HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P O Box 270370 Fort Collins, CO 80527 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA: Zurich Bath, Inc. INSURER B: National Union Fire Insurance P. 0. Box 1966 INSURERC: Pinnacoi Assurance Fort Collins, CO 80522 INSURER D: INSURER E: CAVFRAr:FS 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. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE E (MMIICY DD/YYE POLICY DATE MWDD/YY EXPIRATION LIMITS A GENERAL LIABILITY CP0369701303 11/01105 11101106 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE 51OCCUR IMIAGE TO RENTED nc.,$30-0 OOO MED EXP (Any one person) $1 U 000 PERSONAL & ADV INJURY $1 000 000 X PD Ded:250 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 POLICY J ECPROT LOC A AUTOMOBILE LIABILITY ANYAUTO CP0369701303 11/01/05 11/01/06 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X BODILY INJURY (Per accident) $ HIRED AUTOS NON-OWNEDAUTOS X X PROPERTY DAMAGE (Per accident) $ Drive Other Car GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG B EXCESS/UMBRELLA LIABILITY BE9035696 11/01/05 11/01/06 EACH OCCURRENCE $2000000 X OCCUR CLAIMS MADE AGGREGATE s2,000,000 $ DEDUCTIBLE $ X RETENTION $ 10000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITYY ANY PROPRIETOR/PARTNER/EXECUTIVE 4015110 11/01/05 11101/06 TH- X I OR WC STA7U- OER E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE s500,000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS cr:OPM LZ10 900Z City of Fort Collins - Purchasing 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 _40 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 AUTHORIZED REPRESENT TIVE F_/OaoC T j-JW-,Rbo...f INs..�.r.�vL i•sc. ACORD 25 (2001/08) 1 of 2 #M329654 KLB © 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. �•�� "��, Z ors rrMszabaa