HomeMy WebLinkAboutLARIMER HUMANE SOCIETY - INSURANCE CERTIFICATE (2)_ACDRD„ CERTIFICATE OF LIABILITY INSURANCE
PRODUCER (303)776-5122 FAX (303)776-5495 THIS CERTIFICATE IS ISSUED AS.
First MainStreet Insurance ONLY AND CONFERS NO RIGHTS
512 4th Avenue HOLDER. THIS CERTIFICATE DOE
ALTER THE COVERAGE AFFORDE
P.O. Box 847
Longmont, CO AOS02 INSURERS AFFORDING COVERAGE
'itisaii6-1-arimer Humane Society �- INSURERA: Great American Insul
PO Box 272450 INsuI:Ea¢: pinnacol Assurance
Fort Collins, CO 80525 1INSURER C'
INSURER E:
DATE (MMODIYYYY)
04/25/2008
NAIC #
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 AFFORDCD 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
Im
DD'hal
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION Gi
LIMITS
GENERAL
LIABILITY
PACS373770
OS/01/2008
05/01/2009
EACH OCCURRENCE
s 1,000, 000
A
X
COMMERCIAL GENERAL LIABILITY
MADE—" ��
CLAIMSMADE" 7 OCCUR
DAMAGE *10 RENTED
R
$ 100, 000
_
CXP ((Fa
MED EXP (Any one person)
$ 10 r QQQ
PERSONAL &AOV INJURY
$ 1,000,000
^
_._
GENERAL AGGREGATE
S 2r000,000
GF.N'L AGGRLGA'1'E LIMIT APPLIES PER:
POLICY PRPECT LOC
J
_._._.._........_...._.___.___.
PRODUCT'S COMP/OPAGG
—
$ 21000,000
.--.
AUTOMOBILE
X
LIABILITY
ANY AUTO
CAPS373 771
05/01/2008
05/01/2009
COMBINED SINGLE LIMIT
(Ea accidenU
_
S
1r000r00Q
BODILY INJURY �
(Per porson)
$
A
All. OWNED AUTOS
SCHEDULED AUTOS
HIREDAU'fOS
NON -OWNED AUTOS
X
X
BODILY INJURY
(Per Accident)
PROPERTY DAMAGE
(Poraccidenn
$
—
--
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANYAUTO
—
0'I FIGR THAN EA ACC
AUTO ONLY: AGO
$
$
A
EXCESSIUMBRELLALIABILITY
OCCUR CLAIMS MADE
UMB5373772
05/01/2008
05/01/2009
EACHOCCORRENCE
S 7,000,000
AGGREGATE
£ 1 000,0QO
_.._...__
._!_..._
$
DEDUCTIBLE
_ _
S
RETENTION $
$
WORKERS COMPENSATION AND
RMPLOYF.RS' LIABILITY
4015370
Q7/Q1/2OQ]
Q7/Q1/2QQ$
X WC STATtI OrH-
E.L. EACH ACCIDENT
'----
._..............
$ 1QQ, 000
B
ANY PROPRIETOR/PARTNERIEXECUTWE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - EAEMPLOYEE
$ 10Q,000
E.L. DISEASE, POLICY LIMIT
....._
$ 500,00
I
OTHER
_
—
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
ertificate Holder as Additional Insured as required by written contract per policy form.
City of Fort Collins
Purchasing Department
Attn: James O'Neil
PO Box 580
Fort Collins, CO 80522
ACORD 25l2nn1/nai FAX: (970)2
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEPT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.