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Home My WebLink AboutINSITU INC - INSURANCE CERTIFICATEACORD., CERTIFICATE OF LIABILITY INSURANCE 09/TE 03/2009vvv) 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 In -Situ, Inc. 221 E Lincoln Ave Fort Collins, CO 80524 INSURER A: One Beacon INSURERS: Pinnacol Assurance 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 MFFECTIY POLICE EXPIRATION DATE EXPIRATION LIMITS A GENERAL LIABILITY 7110108440000 09/01/09 09/01/10 EACH OCCURRENCE $1 000 000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $500 000 CLAIMS MADE aOCCUR MED EXP(Any one person) $10000 PERSONAL &ADV INJURY $1000000 GENERAL AGGREGATE s2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2000000 POLICE 0 PRD LOC A AUTOMOBILE LIABILITY ANY AUTO 7110108440000 09/01/09 09/01/10 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X BODILY INJURY (Per accident) $ HIREDAUTOS NON-OWNEDAUTOS X X PROPERTY DAMAGE (Per accident) S Drive Other Car GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHERTHAN EA ACC S ANY AUTO $ AUTO ONLY: AGG A EXCESS/UMBRELLA LIABILITY 7110108440000 09/01/09 09/01/10 EACH OCCURRENCE $5.000000 OCCUR CLAIMS MADE X AGGREGATE $5 000 000 S DEDUCTIBLE X $ RETENTION $ 0 B WORKERS COMPENSATION AND 4126084 09/01/09 09/01/10 - OTH- EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE DENT MEMPLOYEE $1 000 000 >_—„— AEMPLOYEE - $1,000,000If OFFICERIMEMBEREXCLUDED' yes, describe underSPECIAL PROVISIONS below OLICY LIMIT $1000000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS RE: 221 E. Lincoln Ave Ft. Collins, CO Coverage is for replacement cost, Special Form, $5,000 Deductible. City of Fort Collins 300 Laporte Ave Fort Collins, CO 80526 I ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION iEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _30_ DAYS WRITTEN TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE y F" lwnei 'U 4.a. ,LP J �a>d�„1 „K•` e f rP .n.nJCJt o .%edt ACORD 25 (2001108) 1 of 2 #S475931/M475919 KXH 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 #S475931/M475919