HomeMy WebLinkAbout149450 BOULDER DESIGN ALLIANCE - INSURANCE CERTIFICATE,a►coizo® CERTIFICATE OF LIABILITY INSURANCE
11-05/-2010
THIS CERTIFICATEIS 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 SUBROGATIONIS 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/PHS
341438 P:(866)467-8730 F:(877)905-0457
CONT CT
NAME:
A/OC"nfo Ext: (866) 467-FAX
8730 (A/C No): (877) 905-0457
-�f-
PO BOX 33015
SAN ANTON I O TX 78265
ADDRESS:
CUSTOMER ID N:
INSURER(S) AFFORDING COVERAGE
NAIC H
INSURED
BOULDER DESIGN ALLIANCE MR. ROB
DEKIEFFER
INSURER A : Hartford Casualty Iiis CO
INSURER B
3002 MELISSA LN.
INSURERC:
INSURER D
BOULDER CO 80301
-INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
I 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.
LTPOLICY
R
TYPE OF INSURANCE
INSR
WVD
POLICY NUMBER
IMM/DD/YYYY)
EXP
IMM/DD/YYYY) ( LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE $ 11000, 000
—
PREMISES IEa occurrence) S 300,000
A
I CLAIMS -MADE �I OCCUR
X General Liab
34 SBA LJ6557
01/01/2011
VIED EXP (Any one person) I $ 10,000
01/01/2012 PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE S 2,000,000
fLGENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG 3 2,000,000
FRO -_I POLICY X I JECT ElLOC
I
S
AUTOMOBILE
—^
LIABILITY
ANY AUTO
EOMBIIN1EDtSINGLE LIMIT
3 1, 000,000
I BODILY INJURY (Per person)
� $
'
A
ALL OWNED AUTOS
SCHEDULED AUTOS
I
I HIRED AUTOS
34 SBA LJ6557
01/01/2011
01/01/2012
BODILY INJURY (Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
X
NON -OWNED AUTOS
$
$
�I
UMBRELLA LIAR OCCUR
EACH OCCURRENCE
$
EXCESS LIAB CLAIMS -MADE
AGGREGATE
l $
DEDUCTIBLE
I�I
RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOMPARTNER/EXECUTIVE1 (N
OFFICERWEMBEREXCLUDED7 u
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
/ A
TN
I ORY LIM TS I OER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE!$
E.L. DISEASE - POLICY LIMIT S
i
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
Those usual to the Insured's Operations.
l,Cr111rIL,AIt nvLLJtM UANL:tLLAIIUN
City of Fort Collins
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.
AUTHORIZE.Q R9PRESENTATIVE `
1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD