HomeMy WebLinkAbout132766 LONGS PEAK BOULDER COUNTY REACH PROGRAM - INSURANCE CERTIFICATEAC_ORD CERTIFICATE OF
DATE(MMIDD/YYYY)
LIABILITY INSURANCE
Q4/OS/2QQ9
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
MARSH USA INC.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1225 17TH STREET, SUITE 2100
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
DENVER, CO 80202-5534
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
402252-00124-GAWPD-09-10
INSURERS AFFORDING COVERAGE NAIC #
INSURED
INSURERA Insurance Company Of The State Of PA 19429
BOULDER COUNTY COLORADO
2025 14TH STREET, FIRST FLOOR
INSURER B. NIA N/A
BOULDER, CO 80306
INSURER N/A IA
INSURER
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 BY PAID CLAIMS.
_REDUCED _ __
NSR NDO' TYPE OF INSURANCE POLICY NUMBER 0ICY EFFECTIVE- POLICY EXPIRATION -IT
INSR LIMITS
LTR
DATE(MMIDDIYY) DATE(MMIDDNY)
GENERAL LIABILITY
EACH OCCURRENCE
INCLUDED
X COMMERCIAL GENERAL LIABILITY
_
DAMAGETORENTED
$ INCLUDED
A
---
6907904
01/01/09
01/01/10
PREMISES(Ea occurencel
_
CLAIMS MADE OCCUR
MEDEXP(A¢yoneperson)
$ NON
X--$250,000 SIR-._ _-
PERSONALSADV INJURY
_—
$ INCLUDED
GENERAL AGGREGATE
$ 5 000,O0
GENERAL AGGREGATE LIMIT APPLIES PER
-.- --- PRP -
-- �- -
PRODUCTS-COMP/OP AG
- ——
50OQ000'
X POLICY JECT LOC
"_""—'-_-__ _
'-
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
$
ANY AUTO
(Ea accident)
ALLOWNEDAUTOS
--
6001LYINJURV
$
SCHEDULEDAUTOS
(Per person)
HIRED AUTOS
BODILY INJURY
$
NON -OWNED AUTOS
Fer accident)
__...
----
PROPERTY DAMAGE
$
----
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANYAUTO
OTHER THAN E4 ACC
$
AUTO ONLY:
$
AGG
EXCESSIUMBRELLA LIABILITY
EACH OCCURRENCE
$
_ OCCUR F�l CLAIMS MADE
AGGREGATE
$
-
$
DEDUCTIBLE
-
$
RETENTION $
WORKERS COMPENSATION AND
WC STATUOTH-
EMPLOYERS'LIABILITY
IIOAYIIMITS EFL_
_
ANY PROPRIETORIPARTNER/EXECUTIVE
L. EACH ACCIDENT
$
OFFICER/MEMBER EXCLUDED?
.L. DISEASE - EA EMPLOYE
$
$
SPECIAL PROVISIONS belorvP.L.
DISEASE - POLICY LIMIT
OTHER
DESCRIPTION OF O P E RATIO N SILOC ATIONSIVE H IC LESIEXC LUSIO NS ADDED BY E N 00 RS EMENTIS PEC IAL PROVIS IO NS
CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED AS THEIR INTEREST MAY APPEAR TO THE GENERAL LIABILITY POLICY.
CERTIFICATE HOLDER SEA-001345559-01
CANCELLATIONS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
CITY OF FORT COLLINS
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
ATTN: PURCHASING DIVISION
30-_-- DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
PO BOX 580
FORT COLLINS, CO 80522
BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND
THE INSURER, ITS AGENTS OR REPRESENTATIVES,
NU�rPON pprs
Aof M9anEUSA 1.C.eENTATIVE v
tit -clyf' rc e�
Sharon A. Hammer
A4VtiU 20 (LUUT/UC) O 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.