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HomeMy WebLinkAboutLARIMER HUMANE SOCIETY - INSURANCE CERTIFICATE (3)IMPORTANT If the certificate holder is an ADDITIONAL INSURED the policy(tes) 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 ACORD25S(7197)2 of 2 ##M533978 Chant* A6759 INTCON6 ACORp. CERTIFICATE OF LIABILITY INSURANCE DATE 06102108Dm) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Van Gilder Insurance Corp 700 Broadway Suite 1000 Y ONLY HOLDER ALTER AND CONFERS NO RIGHTS UPON THE CERTIFICATE THIS CERTIFICATE DOES NOT AMEND EXTEND OR THE COVERAGE AFFORDED BY THE POLICIES BELOW Denver CO 80203 303 837 8500 INSURERS AFFORDING COVERAGE INSURED Interwest Consulting Group 1076 Lincoln Place Boulder CO 80302 INSURER Hartford Casualty Insurance Co INSURER B Hartford Insurance Group INSURER C Hartford Accident and Indemnity Co INSURER D XL Specialty Insurance Company 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 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM DDm POLICY EXPIRATION DATE MM/DOm LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE [j] OCCUR 34SBAPA7634 06/01/08 06/01/09 EACH OCCURRENCE $2 00Q 000 FIRE DAMAGE (Any me fire) $1000000 MED EXP (Any one person) $10 000 PERSONAL S ADV INJURY s2,000,000 GENERAL AGGREGATE s4,000,000 GEN L AGGREGATE LIMITAPPL IES PER 17 POLICY PRC LOC PRODUCTS COMPIOPAGG $4000000 B AUTOMOBILELIABILrrY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON OWNED AUTOS 34UECN04896 06/01/08 06/01/09 COMBINED SINGLE LIMIT (Ea accident) $1000000 X BODILY INJURY (Per parson) $ X BODILY INJURY (Par accident) $ X PROPERTYDAMAGE (Par acmdent) $ GARAGE LIABILITY ANY AUTO AUTOONLY EAACCIDENT $ OTHER THAN EA ACC AUTO ONLY AGO $ S A EXCESS LIABILITY X OCCUR CLAIMS MADE DEDUCTIBLE X RETENTION $1 O 00O 34SBAPA7634 06/01/08 06/01/09 EACH OCCURRENCE $1 000 000 AGGREGATE $1 00O 000 It $ Is C WORKERS COMPENSATION AND EMPLOYERS LIABILITY 34WEGKC7038 06/01/08 06/01/09 X WCSTATU OTH EL EACH ACCIDENT $1 000000 E L DISEASE EA EMPLOYEE $1 000 000 E L DISEASE POLICY LIMIT $1 000 000 D OTHER Professional iability laims Made DPR9607455 11/14/07 11/14/08 $2 000 000 per claim $2 000 000 annl aggr DESCRIPTION OF OPERATIONS/LOCAnONSA/EHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS City of Fort Collins Attn James B O Neill 281 N College Avenue Fort Collins CO 80521 SHOULD ANYOFTH E ABOVE D ESCRIBED POLICIES BE CANCELLED BEFORE TH E EXPIRATION DATE THEREOF THE ISSUING INSURER WILL ENDEAVOR TO MAIL g0_ DAYS W RITTEN NOTICE TO THE CERTIFICATE HOLDER NAM ED TOTH E LEFT BUT FAILURE TO DOSOSHALL IM POSE NO OB LIGATION OR LIAB ILITY OF ANY KIND U PON TH E INSU RER ITS AGE NTS OR AUTHORIZESE�TIVE_ SS C1lVJ ADUHD Zs 5 (//Ul)1 of 2 #M533978 CDW © 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 ACORD255(7/97)2 of 2 #M533978 ACORP CERTIFICATE OF LIABILITY INSURANCE 06io3/20 8 PRODUCER (303) 776-5122 FAX (303) 776-5495 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION First MainStreet Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND EXTEND OR S12 4th Avenue P 0 Box 847 Longmont CO 80SO2 INSURED Larimer Humane Society Larimer Animal Protection and Control 5137 South College Avenue Fort Collins, Colorado 805025 rnvooer_cc INSURERS AFFORDING COVERAGE INSURERA Great American Ins INSURER Pinnacol Assurance INSURER C INSURER D INSURER E 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 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 ADDIL TYPE OF INSURANCE POLICY NUMBER POLICYEFFECTIVE POLICYEXPIRATION LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE T OCCUR PAC537377004 05/01/2008 05/01/2009 EACH OCCURRENCE $ 1 000 Og DAMAGE TO RENTED $ 100,000 $ 10,000 MED EXP (Any one Person) PERSONAL $ADVINJURY $ 1 000,00 GENERAL AGGREGATE $ 2,000,00 GEN L AGGREGATE LIMIT APPLIES PER POLICY ECT LOC PRODUCTS COMP/OPAGG $ 2 000 00 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON OWNED AUTOS CAP537377104 05/01/2008 0S/01/2009 COMBINED SINGLE LIMIT (Ea eccltlent) $ 1,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per amidenl) $ X PROPERTY DAMAGE (Par accident) $ GARAGE LIABILITY ANY AUTO AUTOONLY EAACCIDENT $ OTHER THAN EA ACC AUTO ONLY AGG $ $ A EXCESSIUMBRELLALIABILITY X OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ UMBS37377204 05/01/2008 OS/01/2009 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 $ $ $ B WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? If yes deunder SPECIALSonse PROVISIONS below 4015370 4015370 07/01/2008 07/01/2007 07/01/2009 07/01/2008 X WCSTATU I I OTH EL EACH ACCIDENT $ 100,00 E L DISEASE EA EMPLOYE $ 100 00 E L DISEASE POLICY LIMIT $ 500,00 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / 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 P 0 Box S80 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 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY AUTHORIZED REPRESENTATIVE Shellv Sawver/SHELLY ACORD 2512001/OaT FAX nernon rneenewr,na, aeee