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HomeMy WebLinkAboutCITY OF FORT COLLINS - INSURANCE CERTIFICATE (6)ACORD05/20/,N CERTIFICATE OF LIABILITY INSURANCE DATEIMM10DD 8/YYYY) PRODUCER 1-303-773-9999 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Arthur J. Gallagher Risk Management Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 6399 S. Fiddlers Green Cir ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 200 Greenwood Village, CO 80111 Contact: Tracy Paladino INSURERS AFFORDING COVERAGE NAIC # INSURED - .. Prrnceton Excess & Surplus Ina 10786 City of Fort Collins INSURERA INSURERB:Midwest Employers Cas Co 23612 P O Box 580 Fort Collins, CO 80522 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, ETR INSR OD'y _ - -- - POLICYEFPECTIVE POLI(VE%PIRATION N RD POLICY NUMBER DATE MM DO YY M DD YY -- LIMITS A GENERAL LIABI LITY N1A3RL000004801 04/15/08 04/15/09 EACH OCCURRENCE $500,000 X _COMMERCIAL GENERAL LIABILITY — _l DAMAGETORENTED PREMISES(Eaocc renceL $ CLAIMS MADE LX. OCCUR MEDEXP(Any one person) S X� SIR $500,000 Per Occ. PERSONAL& ADV INJURY $ GENERAL AGGREGATE $500,000 GEN'L AGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/OP AGG S PRO- POLICY E T17 LOG _ GL & AL Retained Limit Policy A AUTOMOBILE LIABILITY N1A3RL000004801 04/15/08 04/15/09 X- COMBINED SINGLE LIMIT SINCLUDED ANYAUTO (Eaaccident ALL OWNED AUTOS ( BODILY INJURY SIN I SCHEDULEDAUTOS (Per pars..) -- HIREDAUTOS BODILY INJURY $GEN/EXCESS NON -OWNED AUTOS ( (Peracciden0 X General & Auto List. -Li ------ PROPERTY DAMAGE $LIABILITY • X Retained Retained Limit Policy (Per accident) GARAGE LIABILITY (AUTO ONLY-EAACCIDENT S ANYAUTO OTHER THAN _EA ACC S_, AUTOONLY: AGG $ A EXCESS/UMBRELLA LIABILITY N1A3F0000000601 04/15/08 04/15/09 EACH OCCURRENCE S2 500,000 X OCCUR CLAIMS MADE AGGREGATE $ 5 500, 000 5 DEDUCTIBLE $ RETENTION $ B WORKERS COMPENSATION AND EWC005901 04/15/08 04/15/09 X WCSTATU OTH- LORV LIMITS ER EMPLOYERS'LIABPARTILITY EL ANYPROPRIETOREXCLUDED?ECUTIVE EACH ACCIDENT $1,000,000 OFFICER/MENDER EXCLUDED? EL DISEASE -EA EMPLOYEE $1 000,000 Ifyes,describe under ------ --- --- SYECIALPROVISIONSbelow ELDISEASE-POLICYLIMIT S1 000, 000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS Princeton Excess & Surplus Linea Insurance Retained Limit Liability Policy Form includes coverage for General & Auto Liability per endorsements RL 2032 & 2032A, Law Enforcement Liaiblity per form RL 2015 and Wrongful Acts Liability per form RL 1000 LDEC & RL 1000 WROC. Retained Limit Policy Limit is Combined Single Limit per occurrence. For WC Policy - Self Insured Retention of $400,000 (CLASS CODE #7539 SIR of $750,000). Re: LogistiCare is named as Additional Insured as respects General Liability regarding Dial -A -ride for the new Medicaid agreement with LogistiCare. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION LogistiCare Solutions LLC DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Allen & Arapahoe aIMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 3989 E ArapRd Ste 120 R REPRESENTATIVES. Centennial, CO 80122 AUTHORIZED REPRESENTATIVE USA ACORD 25 (2001/08) trapal ����©iACORD CORPORATION 19SR 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. AUVKU ZJ tZUUINU)