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Home My WebLink About467727 DRAHOTA COMMERCIAL LLC - INSURANCE CERTIFICATE (7)ACORD,. CERTIFICATE OF LIABILITY INSURANCE 7/1/2011 DAT11/30/20 PRODUCER Lockton Companies, LLC Denver 8110 E Union Avenue Suite 700 Denver CO 80237 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # (303) 414-6000 INSURED Drahota Commercial, LLC INSURER A: Zurich American Insurance. 1054659 PO Box 272269 Fort Collins, CO 80527 INSURER B : Pinnacol Assurance INSURER c : Navigators Insurance Company 42307 INSURER D : INSURER E : rnvFRAC.FC DRAC001 VA IRIiI CRIn i1 A I C Vr nVJURnI MC uvaa IVV I I nia i i i U i C M VVni i RM i wCi vv ,, in�iJJYn TU-17— 15-15MOCMTA711/C nD DDnnnreD AMn TUC eGDTICIeeTo unI nCD 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 ADDT INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 'RENT Eaoccurence $ 300.000 A `� COMMERCiALGENERALLIABILIY CP0375796407 12/1/2010 12/1/2011 CLAIMS MADE FRE OCCUR MED EXP (Any one person) $ 10000 PERSONAL & ADV INJURY $ 1 00,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY X PRO- JECT X LOC A AUTOMOBILE LIABILITY ANY AUTO CP0375796407 12/1/2010 12/1/2011 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ XXXXXXX ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ XXXXXXX HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ XXXXXXX GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ XXXXXXX ANY AUTO NOT APPLICABLE OTHER THAN EA ACC $ XXXXXXX $ XXXXXXX AUTO ONLY: AGG C EXCESS/UMBRELLA LIABILITY X OCCUR CLAIMS MADE SEIOEXC7196551V 12/1/2010 12/1/2011 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 $ XXXXXXX' UMBRELLA $ XXXXXXX DEDUCTIBLE FORM $ XXXXXXX RETENTION $ B WORKERS COMPENSATION AND - 2286970 7/1/2010 - 7/1/2011 X, WC STATU- I JOTH- TORY LIMITS ER EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE FN I E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: Poudre Valley Authority Fire Station #4. The City of Fort Collins and Belford Watkins Group, LLC, along with their respective officers, agents and employees, are included as Additional Insureds as respects Liability. f`CDTICIr ATC Wnl 111=0 rANIrFI I ATWIRI 10539074 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Fort Collins DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 0 DAYS WRITTEN 215 N. Mason - First Floor Fort Collins, CO 80522-0580 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRES T E yi5�01v,/ ACORD 25 (2009/01) a1988-2009 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD nn Fnr eetinne reen nardinn thie rtifir.atne . nntaen t the nmher hided in the 'Prn nrer cactinn above and cnac.Kv the Niant cnda 'nRACO0V. SENTRY INSURANCE A MUTUAL COMPANY STEVENS POINT, WISCONSIN (A PARTICIPATING MUTUAL COMPANY) A MEMBER OF THE SENTRY FAMILY OF INSURANCE COMPANIES • E, • CERTIFICATE OF INSURANCE ACCOUNT NUMBER 49-99863 This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extlend or alter the coverage afforded by the policies below. Name and Address of Name and Address of the Insured CITY OF FORT COLLINS ROLEXIS DBA 215 N MASON ST 2ND FLR TEAM SPORT PHOTO STUDIO 2000 POIBOX 580 11880 UPHAM ST, UNIT A FORT COLLINS, CO 80522 BROOMFIELD, CO 80020 Thi's certificate is issued on 01-01-2011 and is effective until 0-1-101-2012. I-t certifies that policies of insurance listed below have been issued to the insured named above. 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. Coverage Provided Policy Number Coverage Limits Businessowners Liability 49-99863-01 Each Occurrence S 11000,000 Medical Expense $ 10,000 Includes: Bodily Injury Damage to Premises S 100,000 Property Damage General Aggregate S 3,000,000 Personal Injury Products Aggregate S 31000,000 Hired and Non -Owned Auto If any of the listed policies are cancelled prior to their normal expiration date, the insurer will send notice to the certificate holder 10 days in advance. 80-C1035 (MECH) TEA 49-99863 10-15-2010 PAGE 1 (0009) 31-060501 01T WORG 04177 • CITY OF FORT COLLINS 215 N MASON ST 2ND FLR PO BOX 580 FORT COLLINS, CO 80522 • •