HomeMy WebLinkAbout193076 RISK REMOVAL - INSURANCE CERTIFICATE._� db
CERTIFICATE OF LIABILITY INSURANCE
DATE
1
10/4/2010
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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).
PRODUCER
Van Gilder Insurance Corp.
1515 Wynkoop, Suite 200
Denver CO 80202
CONTACT
PHONE
aC No Ext: 0 - 7- 00 AIC,No: - 5225
E-MAIL
ADDRESS:
PRODUCER
CUSTOMER ID M
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURED
Morrow Holdings, LLC.
INSURER A: American International Underwr
INSURER B: Commerce and Industry Insuranc
dba Risk Removal, LLC.
INSURER C: Pinnacol Assurance
1925 Timberline Rd, Office I
Fort Collins CO 80525
INSURERD:
INSURER E :
INSURER F :
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TR
TYPE OF INSURANCE
IANSR
WVD
POLICY NUMBER
CFF
MM DIDY/YEYW
MM/DCDY EXP
LIMITS
A
GENERAL LIABILITY
Y
Y
PROP1064650
10/1/2010
10/1/2011
EACH OCCURRENCE
$1,000,000
X COMMERCIAL GENERAL LIABILITY
-
—
DAMAGE TO RENT D
PREMISES Ea occurrence
$ 300, 000
MED EXP (Any one person)
$25,000 --
CLAIMS -MADE OCCUR
--
PERSONAL & ADV INJURY
$1,000,000
"
'-
GENERAL AGGREGATE
$2,000,000
-
kIN'LAGGREGATELIMITAPPLIESPER:
POLICY X PRO- LOC
PRODUCTS-COMP/OPAGG
$2,000,000
$
B
AUTOMOBILE
LIABILITY
ANY AUTO
Y
Y
CA4961074
10/1/2010
10/1/2011
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
X
BODILY INJURY (Per person)
$ -
ALL OWNED AUTOS
BODILY INJURY (Per accident)
$
SCHEDULED AUTOS
PROPERTY DAMAGE
(Per accident)
$
HIRED AUTOS
$
NON -OWNED AUTOS
A
X
UMBRELLA LIAB
X
OCCUR
PROU1954986
10/1/2010
10/1/2011
EACH OCCURRENCE
$2,000,000
AGGREGATE
$2,000,000
-
EXCESS LIAB
CLAIMS -MADE
HXDEDUCTIBLE
RETENTION $10,000
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
N / A
Y
4063346
10/1/2010
10/l/2011
X WC STATU- OTH-
OR IMITS R
E.L. EACH ACCIDENT
$1,000,000
IMandatoryinund NH)
If yes, describe under
E.L. DISEASE - EA EMPLOYE
$1,000,000
E.L. DISEASE - POLICY LIMIT
$1, 000, 000
DESCRIPTION OF OPERATIONS below
A
Pollution Liability
PROP1064650
.
10/l/2010
10/1/2011
$1,000,0o0 Occurrence
$2, 000, 000 Aggregate
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Re: Water Utilities, 700 Wood Street, Fort Collins, CO
As required by written contract or written agreement, the Certificate Holder is included as Additional
Insured for ongoing operations under General Liability with respect to the above referenced.
IVI�
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED
City of Fort Collins IN ACCORDANCE WITH THE POLICY PROVISIONS.
Purchasing
PO Box 580
AUTHORIZED REPRESENTATIVE
Fort Collins CO 80522-0580
v 1 000-cvvU Mi ,vrtu t.UKYUKA I IUN. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD