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CITY OF FORT COLLINS CAPITAL LEASING CORPORATION - INSURANCE CERTIFICATE
ACORD. CERTIFICATE OF LIABILITY PRODUCER (303) 773-9999 FAX Arthur J Gallagher & Co - Denver INSURANCE (DATE07/16//2004) 004 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6399 S Fiddlers Green Circle, Suite 200 Greenwood Village CO 80111 HOLDER THIS CERTIFICATE DOES NOT AMEND EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW INSURERS AFFORDING COVERAGE NAIC # INSURED City of Fort Collins P 0 BOX 580 Ft Collins CO 8OS22 INSURERA Genesis Insurance Company INSURERS Lexington Insurance Company INSURER INSURER D INSURER E 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 hm DD' TYPE OF INSURANCE POLICY NUMBER POLICYEFFECTIVE I 01/01/2004 POLICYEXPIRATIONDATE a- 04/15/2005 LIMITS A X GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE aOCCUR X SIR $2SO,000 Per YXB300654E COV A -GENERAL LIAB AUTO LIAB , LEL LIAB B - PUBLIC OFFICIALS EACH OCCURRENCE $ 3,000.000 DAMAGE TO RENTED $ $ MED EXP(Any one Person) PERSONAL& ADV INJURY $ Occurrence COV GENERAL AGGREGATE $ 6,000,00 GEN L AGGREGATE LIMIT APPLIES PER PRO LOC X POLICYF-j JECT LAIBILITY PRODUCTS COMP/OPAGG $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea amdent) $ X ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTO$ NON -OWNED AUTOS BODILY INJURY (Per a.dent) $ PROPERTY DAMAGE (Per a.d t) $ GARAGE LIABILITY AUTOONLY EAACCIDENT $ ANY AUTO OTHER THAN EAACC AUTO ONLY AGO $ S EXCESS/UMBRELLA LIABILITY OCCUR CLAIMS MADE EACH OCCURRENCE $ $ DEDUCTIBLE a RETENTION $ S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OTH 4�CH NTOFFICERIMEMBER ANY PROPRIETOR/PARTNER/EXECUTIVE EXCLUDED? Syas desmbeurxferEMPLOYE SPECIAL PROVISIONS below $ LICY LIMIT $ Broperty-Special rTHER Form nkt Bldg & Pers Prop 9752796 INCLUDES AUTOMOBILE 01/01/2004 04/15/2005 Per Occurrence $100 000 000 Policy Deductible $SO,000 PHYSICAL DAMAGE Vehicle Deductible $100 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS e Fort Collins Capital Leasing Corporation is named Additional Insured as respects General iability coverage regarding the Lease Agreement dated July 27, 2004 for Deicing Facility which erminates on June 1, 2023 and for Police Building which terminates on June 1, 2026 Fort Collins Capital 215N Mason Street PO BOX 580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF THE ISSUING INSURER WILL ENDEAVOR TO MAIL Leasing Corporation 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Fort Collins CO 80522 AUTHORIZED REPRESENTATIVE V Karen Graham/NMS ©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