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Home My WebLink AboutLARIMER HUMANE - INSURANCE CERTIFICATE,a CERTIFICATE OF LIABILITY INSURANCE 06/07/2 08 PRODUCER (303) 776-5122 FAX (303) 776-S49S First Mal nStreet Insurance 512 4th Avenue P 0 Box 847 Longmont, CO 80S02 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 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW INSURERS AFFORDING COVERAGE NAIC # INSURED Larimer Humane Society Larimer Animal Protection and Control 5137 South College Avenue Fort Collins, Colorado 8OS025 INSURERA Great American Insurance Co INSURERS Pinnacol Assurance INSURER INSURERD NSURER 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 133L WUL UMDATE TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE IMINDDIVY1 POLICY EXPIRATION DATE 1MMJDnrM LIMITS GENERAL LIABILITY PACS37377004 OS/01/2008 OS/01/2009 EACH OCCURRENCE $ 1,000,00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RPRFMIRFS'FeENTED $ 100,00 CLAIMS MADE OCCUR $ 10,000 MED EXP (Any one person) A PERSONAL S ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,00 GEN L AGGREGATE LIMIT APPLIES PER PRODUCTS COMP/OPAGG $ 2,000,000 POLICY JECT LOC AUTOMOBILE LIABILITY ANY AUTO CAPS37377104 05/01/2008 OS/01/2009 COMBINED SINGLE LIMIT (Ea accident) $ 1, 000 , 0O X BODILY INJURY (Per person) $ A ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON OWNED AUTOS X BODILY INJURY (Per accdent) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTOONLV EAACCIDENT $ ANY AUTO OTHER THAN EAACC $ $ AUTO ONLY AGO EXCESSIUMBRELLA LIABILITY X OCCUR CLAIMS MADE UMBS37377204 05/01/2008 05/01/2009 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 A $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND 40IS370 07/01/2008 07/01/2009 X WC STATU OTH a ER B EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? It yee d..be under WePROVISIONS below 4015370 07/01/2007 07/01/2008 EL EACH ACCIDENT $ 100,00 E L DISEASE EA EMPLOYEE $ 100,000 E L DISEASE POLICY LIMIT $ S00 00 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Cityof Fort Collins as Additional Insured as required by written contract per policy form Event Fire Hydrant Five SK Run & 3K Pledge Walk May 10, 2008 City of Fort Collins Attn Risk Management P 0 Box 580 Fort Collins, CO 8OS22-0580 SHOULD ANY OF 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 OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES AUTHORIZED REPRESENTATIVE S U.el I., cam.... —/curl Iv ACORO 2H I2nn1/DRI FAX 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 AGURD Z5 (Z001103)