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Home My WebLink AboutSIMPLEX GRINNELL - INSURANCE CERTIFICATECERTIFICATE OF INSURANCE CERTIFICATE NUMBER 419665 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO PRODUCER RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE Marsh, Inc. POLICIES DESCRIBED HEREIN. 1166 Avenue of the Americas COMPANIES AFFORDING COVERAGE New York, NY 10036 Telephone (212) 345-5000 COMPANY A: Al South Insurance Co. COMPANY B: American Home Assurance Co. INSURED COMPANY C: Commerce & Industry Ins Cc COMPANY D: Illinois National Insurance Co. SimplexGrinneli, LP COMPANY E: Insurance Company of the State of PA 6240 SMITH ROAD DENVER, CO 80216 COMPANY F:_New Hampshme, Ins__Cc __....... ......-______....._..___._......�.. United Slates COMPANY G: New York Marine & General Insurance Co. (Lead) COMPANY H: White Mountain Insurance Co. COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIRMENTS, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES LISTED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY LIMITS LTR DATE(MMI)D/YY) EXPIRATION B GENERAL LIABILITY GL 1595415 6/29/2007 10/1/2008 GENERAL AGGREGATE $15,000,000.00 PRODUCTS - COMP/OP AGG _ $15000,000.00 X COMMERCIAL GENERAL _ CLAIMS MADE X OCCU PERSONAL &ADV INJURY__ _ _�7500,000,00 OWNER'S&CONTRACTOR'S EACH OCCURRENCE $7,500,000.00 FIRE DAMAGE (Any one IS) $1,000000.00 DIED EXP(Any one person) $10000.00 g AUTOMOBILE LIABILITY CA 1606992 MA ( ) 6/29I2007 1011/2008 COMBINED SINGLE LIMIT $7,500,000.00 B X-- ANY AUTO CA 1606993 (VA) 6/29/2007 10/l/2008 B ALLOWED AUTOS CA 1606994(AOS) 6/29/2007 10/l/2008 BODILY INJURY (Per person) SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY (Per X accident) NON -OWNED AUTOS ( PROPERTY DAMAGE PROPERTY EXCESS LIABILITY EACH OCCURRENCE UMBRELLA FORM AGGREGATE OTHER THAN UMBRELLA FORM g WORKERS COMPENSATION AND SEE PAGE TWO SEE PAGE TWO SEE PAGE TWO X , vr"A oBr rs D EMPLOYERS' LIABILITY EL EACH ACCIDENT $2,000,000.00 A F THE PROPRIETOR/ PARTNERSIEXECUTNE INCL EL DISEASE -POLICY LIMIT $2,000,000 .00 EL DISEASE -EACH $2,000,000.00 O OFFICERS ARE: EXC OTHER DESCRIPTION OF OPERATIONS/LOCATIONSWEHICLESISPECIAL ITEMS Please see page 2 for additional insureds and any additional language. CERTIFICATE HOLDER CANCELLATION - City&Count of Ft. Collins SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE y INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER P.O. Box 580 NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON Ft. Collins, CO 80522-0500 TIII' INti11HFH AFF DISI NG f.NVFHACF ITC ACFNTS lIN PFPHFCI�NTATIVFC. DH TIIF ISSIIFfl (IF THIS (;FHin ICgTF MARSH USA INC. BY: David Kong, Casualty Program ' MM1 2 VALID AS OF: 6/24/2008 PRODUCER Marsh, Inc. 1166 Avenue of the Americas New York, NY 10036 Telephone (212) 345-5000 INSURED SimplexGrinnell, LP 6240 SMITH ROAD DENVER, CO 80216 United States COMPANIES AFFORDING CERTIFICATE NUMBER 419665 TEXT WORKERS COMPENSATION POLICIES Carrier Policy Number Eff. Date Exp. Date State (B) American Home Assurance Co. WC 1616576 6/29/2007 6/2.9/2008 CA (D) Illinois National Insurance Co. WC 1616577 6/29/2007 6/29/2008 MI (A) AT South Insurance Co. WC 1616578 6/29/2007 6/29/2008 GA (B) American Home Assurance Co. WC 1616579 6/29/2007 6/29/2008 PA (F) New Hampshire Ins. Co. WC 1616580 6/29/2007 6/29/2008 NY,OH,WI (B) American Home Assurance Co. WC 1616581 6/29/2007 6/29/2008 NJ (C) Commerce & Industry Ins Cc WC 1616582 6/29/2007 6/29/2008 FL (I.) Insurance Company of the State of PA WC 1616583 6/29/2007 6/29/2008 AR,MA,VA (B) American Home Assurance Co. WC 1616584 6/29/2007 6/29/2008 AOS (B) American (tome Assurance Co. WC 1616585 6/29/2007 6/29/2008 OR (B) American Home Assurance Co. WC 1616749 6/29/2008 10/1/2008 CA (D) Illinois National Insurance Co. WC 3.616750 6/29/2008 10/1/2008 MI (A) AI South Insurance Co. WC 3.61.6751 6/29/2008 10/1/2008 GA (B) American Home Assurance Co. WC 3.616752 6/29/2008 10/1/2008 PA (F) New Hampshire Ins. Co. WC 1616753 6/29/2008 10/1/2008 NY,OH,WI (B) American Home Assurance Co. WC 3.616754 6/29/2008 10/1/2008 NJ (C) Commerce & Industry Ins Cc WC 1616755 6/29/2008 10/1/2008 FL (E) Insurance Company of the State of PA WC 1616756 6/29/2008 10/1./2008 AR,MA,VA (B) American home Assurance Co. WC 1616757 6/29/2008 10/1./2008 OR (B) American Rome Assurance Co. WC 1616758 6/29/2008 10/1/2008 AOS (B) American Home Assurance Co. WC 1616759 6/29/2008 1.0/1/2008 TX LIABILITY PROGRAM Project: General If there is a question regarding this certificate please contact Linda Vaughn (Email: livaughn@tycoint.com Phone: 303-355-0500) CERTIFICATE HOLDER City & County of Ft. Collins P.O. Box 580 Ft. Collins, CO 80522-0500