HomeMy WebLinkAboutCITY OF FORT COLLINS - INSURANCE CERTIFICATE (5)ACORD„, CERTIFICATE OF LIABILITY INSURANCE 09I22/DAT221D08O/YYYY)
J. Gallagher Risk Management Services, Inc.
6399 S. Fiddlers Green Cir
Suite 200
Greenwood Village, CO 80111
Contact: Tracy Paladin0
INSURED
City of Port Collins
P 0 Box 580
Fort Collins, CO 80522
COVERAGES
E.
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Lines Ina
THE POLICIES OF INSURANCE- LISTED BELOW IiAVC BEEN ISSUED TO'THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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.
MSR
NW1
POLICY NUMBER
POLICY EFFECTIVE
POLICYE%PIRgT10N
LIMITS
A
GENERAL
LIABILITY
N1A3RL00000480].
04/15/08
04/15/09
FACHOCCURREN(E
$500,000
X
COMMERCIAL GENERALL IAUILITY
-0709TGE
PREMI: ET, occorrnca
- —_— �
$
uOCCUR
CLAIMSMAOE
MEDEXP(Anyoneporson)
$
X
PERSONAL B AOV INJURY
___...
$
SIR $500, 000 Per
_
...... _...._._.... .._._._
._. _..__.....
GENERAI, AGGREGATE
._..______.....
g500, 000
PRODUCTS -COMPfOP AGO
S
GEN'L
AGGREGATE LIMIT APPLIES PER:
POLICY PRO.FCT LOC
__
AUTOMOBILE
1.1 ABILITY
COMBINED SINGLE LIMIT
$
ANY AUTO
(Ea dcCir)eni)
ALLOWNEDAUTOS
- __----------
BODILYINJURY
SCHf:OULEDAU70S
(Per person)
HIRED AUTOS
_
Beracci
$
NON-OWNEO AUTOS
(Peraccidenl)
ent)
PROPERTY DAMAGE
$
(Per eccitlenl)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
Ot'HER THAN EAACC
S
ANYAUTO
AUTOONLY: AGG
$
A
EXCES$/UMBflELLALIABILITY
N1A3F0000000601
04/15/00
04/15/09
EACH OCCURRENCE
$2,500,000
X OCCVH CLAIMS MADE
AGGREGATE
$ 5, 500, 000
s
$
RETENTION $
WORKERS COMPENSATION AND
WC STATU OTH
EMPLOYERS' LIABILITY
DRYJJM'
E.I.. F. ACH ACCIDENT
- ---
$
ANYPROPRIETOMPARTNEWEXECUTIVE
E.L. D$8EASE-EA EMPLOYEE
......
$
O- IC- MEMBEREXCLUDEO?
under
yECIAL
_..
E.L. DISEASE POLICY LIMIT
..._—_...
$
SPECIAL PROVISIONS below
RO
OTHER
DESCRIPTION OFOPERAVONS / LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
For GL Policy - Cov A. - General Liability, Auto Liability, LEL Liability. Cov. 8 Public Officials Liability.
Re: Fort Collins Capital Leasing Corporation is named Additional Insured as respects General Liability Coverage
regarding the Lease Agreement dated July 27, 2004 for Deicing Facility which terminates on June 1, 2023 and for Police
Building which terminates on June 1, 2026,
Collins Capital Leasing Corporation
215 N. Mason Street
P 0 Box 580
Fort Collins, CO 80522.
USA
(2001/08) trapal
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
rnPl3nRATHINI 10nn
IIRY-01-2008 10:38 From:
To:Citu of Fort, Collins R.212
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 endoisement(s).
If SUFROGATION 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.