No preview available
HomeMy WebLinkAbout113967 PROJECT SELF-SUFFICIENCY - INSURANCE CERTIFICATE (2)Clipntft• 35AR1 PROSE ACORD- CERTIFICATE OF LIABILITY INSURANCE DATE 04/29/2009YYr) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Flood & Peterson Ins. Inc. P. 0. Box 578 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE . HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 4687 W. 18th Street Greeley, CO 80632 INSURERS AFFORDING COVERAGE •NAIC #- INSURED Project Self -Sufficiency of Lvld-Ft Col 375 W: 37th St., Suite 150 LoVeland, CO 80538-2261 INSURER A: Ohio Casualty Co INSURER B: INSURER C: INSURER D: • -• 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 REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDDIYY POLICY EXPIRATION DATE MM/DD/YY LIMITS A GENERAL LIABILITY BKO52256750 04/25/09 04/25/10 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL I -(ABILITY CLAIMS MADE D OCCUR DAMAGES I RENTED PREMI E orrrence $100 000 MED EXP (Any one person) $10 000 PERSONAL & ADV INJURY $1,000,000 . GENERAL AGGREGATE $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $1,000,000 POLICY PRO LOC JECT AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ' ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ A GARAGE LIABILITY BNO1052256750 04/25/09 04/25/10 AUTO ONLY - EA ACCIDENT $1,000,000 OTHER THAN EA ACC $1,000,000 ANY AUTO $1,000,000 X 'Owned/Non-Owned AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR ❑ CLAIMS MADE $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY —TTWC STATU- OTH- Y I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS The certificate holder is named as an additional insured as their interest may appear in reference to the named insured's operations in regards to the use of the Repair Shop. City of Fort Collins P.O. Box 580 Fort Collins, CO 80522 GANGtLLA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL I0 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 y� �IZ�.isii� dII"lgad0"+a>�./CR i 1�.ddl�, ACORD 25 (2001/08) 1 of 2 #S442523/M442519 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 #S442523/M442519