HomeMy WebLinkAboutROCKY MOUNTAIN INNOVATION INITIATIVE - INSURANCE CERTIFICATEGhentl;:49137 KMINN '
DATE (MM/DDNYYY)
ACORUM. CERTIFICATE OF LIABILITY INSURANCE 02/17/2009
PRODUCER _ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood & Peterson Insurance Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE - - -- -
4821 Wheaton Drive HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
. . ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P O Box 270370 ?
Fort Collins, CO 80527 INSURERS AFFORDING COVERAGE _NAIC #
INSURED INSURER A: Auto -Owners Insurance Group
Rocky Mountain Innovation Initiative, I INSURER B: Philadelphia Insurance Companies
200 W. Mountain Ave., Suite C INSURER C:
Fort Collins, CO 80521 INSURER D:
INSURER E:
CIIVFRAr;FS
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.
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MMIDDNY
POLICY EXPIRATION
DATE MM/DDNY
LIMITS
A
GENERAL LIABILITY
4755119500
03/01/09
03/01/10
EACH OCCURRENCE
$2 000 000
DAMAGE TO R
PREMISES (EE occurrence)TED
$50000
X COMMERCIAL GENERAL LIABILITY
MED EXP (Any one person)
$5 000
CLAIMS MADE 51OCCUR
PERSONAL & ADV INJURY
$2 000 000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
s2,000,000
rj POLICY PRO LOC
JECT
AUTOMOBILE
LIABILITY
- L.COMBINED
ANY -AUTO
-
_
SINGLE LIMIT.
(Ea accident) -•
$
-
BODILY IN
(Per person)
_
$ -
ALL OWNED AUTOS_
SCHEDULED AUTOS
BODILY INJURY _ .
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
-.
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR F—ICLAIMS MADE
AGGREGATE
$
$
-
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND
WC STATU- OTH-
T YLIMITS
E.L. EACH ACCIDENT
$
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. DISEASE - EA EMPLOYE
$
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
$
B
OTHER Directors &
PHSD311964
03/01/09
03/01/10
1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Certificate holder is named as additional insured as owner/lessor
as regards the following location:
Loc# 1 - 200 W. Mountain Ave., Suite C; Fort Collins, CO
CERTIFICATE HOLDER CANCELLATION
City of Fort Collins
300 Laporte Ave
Fort Collins, CO 80521
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL In DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENT TIVE
ACORD 25 (2001/08) 1 of 2 #S436998/M436997 TLA 0 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.
ACORD 25-S (2001/08) 2 of 2 #S436998/M436997