HomeMy WebLinkAboutJUPITER I LLC DBA OFFICESPACE - INSURANCE CERTIFICATEJUPI
Client#: 2631
ACORD,M CERTIFICATE OF
LIABILITY
INSURANCE
DATE (MM/D
10/01/09DIYY)
PRODUCER
THIS CERTIFICATE
IS ISSUED AS A MATTER OF INFORMATION
Van Gilder Insurance Corp.
1515 Wynkoop, Suite 200
ONLY
HOLDER.
ALTER
AND CONFERS NO -RIGHTS --UPON -THE CERTIFICATE-
THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Denver, -CO - 80202---:-
303 837-8500
INSURERS AFFORDING COVERAGE
INSURED
Jupiter I, L.L.C. DBA: OfficeScapes
9900 E.51stAvenue
Denver, CO 80238
INSURER A:
CNA (CL) - --
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.
INSR
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MM/DD
POLICY EXPIRATION
DATE MMIDD
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE Fx_1 OCCUR
2078647069
10/01/09
10/01/10
EACH OCCURRENCE
$1,000,000
FIRE DAMAGE (Any one fire)
$100,000
MED EXP (Any one person)
$5 000
PERSONAL & ADV INJURY
$1,000,000
GENERAL AGGREGATE
$2 000 000
GEN'L AGGREGATE LIMITAPPLIES PER:
POLICY X PE X LOC
PRODUCTS -COMP/OPAGG
s2,000,000
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
2078647024
10/01/09
10/01/10
COMBINED SINGLE LIMIT .
(Ea accident)
$1,000,000'
X
BODILY. INJURY"
(Per person)
$
X
-'
BODILY INJURY
(Per accident)
$ .
X .
PROPERTY. DAMAGE:
(Per accident)
$ _..
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
_$_
$
A
EXCESS LIABILITY
X OCCUR CLAIMS MADE
DEDUCTIBLE
X RETENTION $10 000
2097984967
10/01/09
10/01/10
EACH OCCURRENCE
$5 000 000
AGGREGATE
s5,000,000
$
$
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
4014202
10/01109
10/01/10
X - T /C STATU- CETH-
R
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE -EA EMPLOYEE
$1,000,000
E.L. DISEASE - POLICY LIMIT
$1,000,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
If required by written contract or written agreement, The City of Fort Collins, Colorado, a Municipal Corporation, its
officers and employees are included as Additional Insureds for ongoing operations under General Liability. *Except 10 days
notice for non-payment of premium.
1a11IWIl:Alt MULUtK I I AD DITIONAL INSURED: INSURER LETTER: GANGtLLAIIUN
The City of Fort Collins, a
Municipal Corporation
Attn: Director of Purchasing & Risk Management
PO Box 580
Fort Collins, CO 80522
SHOULD ANYOF TH E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL30* DAYSWRITTEN
NOTICETOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT, BUTFAILURE TODOSOSHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURE R,ITS AGENTS OR
AUTQJ21Z�p REPj2ESENTAT�IV�E�
(///t,r 4-1 i0z- e�
ACORD 25-S (7/97)1 of 2 #M572059 JXM 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.
ACORD25-S(7/97)2 of 2 #M572059