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HomeMy WebLinkAbout383935 LIGHTLY TREADING INC - INSURANCE CERTIFICATEAl �'® CERTIFICATE OF LIABILITY INSURANCE 9/�/2`oio°"p"' 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 NAME: Dawn Gaba an PHONE FAX _[A/C,No, EXt:3Q3-837-8�QQ Arc,No_303-831-59Q AbDREss: dgabayan@vgic.com PRODUCER CUSTOMER ID#: LIGTRE INSURER(S) AFFORDING COVERAGE NAIC # INSURED Lightly Treading, Inc. 4303 Brighton Blvd., Bldg 3 INSURER A: Hartford Casualty Insurance CO 29424 INSURER B: Hartford Ins Co of the Midwest 0 INSURER C:Travelers Casualty & Surety Co 0 Denver CO 80216 INSURER D : INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 17667712 REVISION NUMBER: 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. !NSR LTR TYPE OF INSURANCE AINSR SU-B-R WVD POLICY NUMBER POLICY MMIDD/YYYY MMIDDYEXP /YYYY LIMITS A GENERAL LIABILITY Y 34SBWVR5402 9/1/2010 9/1/2011 EACH OCCURRENCE $1, 000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED occurrence PREMISESS $1, 000,000 MED EXP (Anyone person) $10, 000 CLAIMS -MADE 17X OCCUR PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY X PRO- LOC $ A AUTOMOBILE LIABILITY Y Y 34SBWVR5402 9/1/2010 9/1/2011 COMBINED SINGLE LIMIT (Ea accident) $1, 000, 000 ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ X SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (Per accident) $ X NON -OWNED AUTOS I $ j $ A X UMBRELLA LIAB X 17I_CLAIIMS-.ADE !OCCUR Y y 34SBWVR5402, 9/1/2010 9/1/2011 EACH OCCURRENCE $3,000,000 AGGREGATE $3,000,000 EXCESS LIAB DEDUCTIBLE $ $ X RETENTION $10,000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ N I A 34WEGIN3841 9/1/2010 9/1/2011 I X I WC STATU- I iOTH- LTORY LIMITS !_ER E.L. EACH ACCIDENT $1, 000, 000 E.L. DISEASE - EA EMPLOYEE $1, 000,000 (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $1, 000, 000 DESCRIPTION OF OPERATIONS below C Professional Liability 105338920 9/1/2010 9/1/2011 Per Claim $1,000,000 Claims Made Annual Aggregate $1, 000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) If required by written contract or written agreement, the following provisions apply subject to the policy terms, conditions, limitations and exclusions: The Certificate Holder and Owner are included as Additional Insureds for ongoing and completed operations under General Liability; Designated Insured under See Attached... CERTIFICATE HOLDER CANCELLATION City of Fort Collins Attn: Purchasing PO Box 580 Fort Collins CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD ACOREP AGENCY CUSTOMER ID: LIGTRE LOC #: AnnITIr1AIA11 OPRAADL(c crw=nl 11 G AGENCY NAMED INSURED Van Gilder Insurance Corp. Lightly Treading, Inc. 4303 Brighton Blvd., Bldg 3 POLICY NUMBER Denver CO 80216 CARRIER ADDITIONAL REMARKS NAIC CODE EFFECTIVE DATE: ITHIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE:CERTIFICATE OF LIABILITY INSURANCE Pans. _ of Automobile Liability; and Additional Insured under Umbrella / Excess Liability but only with respect to liability arising out of the Named Insured's work performed on behalf of the certificate holder and owner. This insurance will apply on a primary, non-contributory basis. A Blanket Waiver of Subrogation applies for General Liability, Automobile Liability, Umbrella/Excess Liability and Workers' Compensation. Limited Contractual Liability is included. The Umbrella / Excess Liability policy provides excess coverage over the General Liability, Automobile Liability and Employers Liability. gkuuKU 7U9 (ZUmmi) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD