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HomeMy WebLinkAboutUNITED WAY OF LARIMER COUNTY - INSURANCE CERTIFICATE (3)Client#: 44961 UNIWA4 ACORDT, CERTIFICATE OF LIABILITY INSURANCE DATE 06/30/2010YYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Flood & Peterson Ins., Inc. Corporate Mailing Address: p g ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. O. Box 578 Greeley, CO 80632 INSURERS AFFORDING COVERAGE NAIC # INSURED United Way of Larimer County 424 Pine Street #102 Fort Collins, CO 80524 INSURER A: Philadelphia Insurance Companie INSURER B: 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 M DD/YY POLICY EXPIRATION DATE M DD Y LIMITS A GENERAL LIABILITY PHPK576291 07/01/10 07/01/11 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $1 OO OOO CLAIMS MADE a OCCUR MED EXP (Any one person) $5 000 PERSONAL & ADV INJURY $1 00O 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 POLICY PECT RO LOC J A AUTOMOBILE LIABILITY ANY AUTO PHPK576291 07/01/10 07/01/11 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X HIRED AUTOS X NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG A EXCESS/UMBRELLA LIABILITY PHUB309105 07/01/10 07/01/11 EACH OCCURRENCE $1 OOO 000 AGGREGATE $1 00O 000 OCCUR CLAIMS MADE $ DEDUCTIBLE $ X RETENTION $ 10 000 B WORKERS COMPENSATION AND 1139172 07/01/10 07/01/11 X WC ORY LIMIT O R " EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. EACH ACCIDENT $500OOO E.L. DISEASE - EA EMPLOYEE $500OOO E.L. DISEASE -POLICY LIMIT $500OOO A OTHER D & O PHSD535308 07/01/10 07/01/11 $1,000,000 Limit Liability $2,500 Deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Certificate Holder is listed as Additional Insured as their interests may appear regarding: Emergency Shelter for the homeless during winter months. a.�n r rrnir� r nvLv�n 6AI10,tLLA I IUIV I U Ua S Tor IVOn-va meat SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Fort Collins: Ann: Jim DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _An DAYS WRITTEN O'Neil, City Purchasing Dept. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL P O Box 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Fort Collins, CO 80522 1 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE AL,UFSu ZO IZUUT/US) 1 of 2 #S541322/M541321 SLS © 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. AGURU 25-s (2001/08) 2 of 2 #S541322/M541321