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Home My WebLink AboutUNITED WAY OF LARIMER COUNTY - INSURANCE CERTIFICATE (4)Client#: 44961 UNIWA4 ACORDre CERTIFICATE OF LIABILITY INSURANCE DATE (MM DD YYYY) 1/13106 PRODUCER Flood & Peterson Insurance Inc 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 4821 Wheaton Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P O Box 270370 Fort Collins, CO 80527 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Philadelphia Insurance Companies United Way of Larimer County 424 Pine Street#102 Fort Collins, CO 80524 INSURER B: Pinnacol Assurance INSURER C: INSURERD: INSURER E: AGES 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. S LTR INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE F OCCUR PPHPK089350 07/01/05 07/01/06 EACH OCCURRENCE $1 000000 DPREMISES (Ea occAMAGE TO RENTEDfarce, $1 OO OOO MED EXP (Any one person) $5 000 PERSONALS AOV INJURY $1 0n000 GENERAL AGGREGATE $2 0 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC PRODUCTS - COMP/OP AGO $20 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS PPHPK089350 07/01/05 07/01/06 COMBINED SINGLE LIMIT (Ea accident) $1 0 r BODILY INJURY (Per person) $ X X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ A EXCESS/UMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE X RETENTION $ 10000 PHUB033921 07101/05 07/01/06 EACH OCCURRENCE $1 000000 AGGREGATE $1 000 000 $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below 1139172 07/01/05 07/01/06 OTH- X WCSTATU-I EEL E.L. EACH ACCIDENT $1 OOOOO E.L. DISEASE - EA EMPLOYEE $100000 E.L. DISEASE - POLICY LIMIT $500OOO OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate Holder is listed as Additional Insured as their interests may appear regarding: Emergency Shelter for the homeless during winter months. City of Fort Collins: Attn: Jim O'Neil, City Purchasing Dept. P O Box 580 Fort Collins, CO 80522 LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL In DAYS WRITTEN ;E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL NO OBLIRATION OR LIABILITY OF ANY KINDVIPON THE INSURER, ITS AGENTS OR ACORD 25 (2001108) 1 of 2 #S336349/M319329 TJR 0 ACORD CORPORATION 1933 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-S (2001/08) 2 of 2 #S336349/M319329