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Home My WebLink About149450 BOULDER DESIGN ALLIANCE - INSURANCE CERTIFICATE (2)/ ® A� o CERTIFICATE OF LIABILITY INSURANCE DATE(MM;DD/YYYY) 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 statementon this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER VAN GILDER INSURANCE CORP/PHS 341438 P: (866)467-8730 F: (877)905-0457 PO BOX 33015 NAME: PHONE I"/CN°Ext): (866)467-8730 (a/c,N°): (877)905-0457 ADDRESS: PRODUCER SAN ANTONI O TX 78265 CUSTOMER ID k: INSURER(S) AFFORDING COVERAGE NAIC k INSURED BOULDER DESIGN ALLIANCE MR. ROB DEKIEFFER 3002 MELISSA LN. BOULDER CO 80301 INSURER A : Hartford Casualty Ins Co INSURERB: INSURER : INSURER D INSURER E INSURER F — -I& rCOTICIrATC nmmIInFR• REVISION NUMBER: a.v V Ln....... .....�. _ ..., ..._—... 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. LTR TYPE OF INSURANCE �INSR WVD POLICY NUMBER (MM/DD/YYYY) I FXP (MM/DD/YYYY) LIMITS GENERAL LIABILITY I EACH OCCURRENCE I $ 1, 0 0 0, 0 0 0 DAIVfA6b 1 U HLN �— COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) I S 3 0 0, 0 0 0 CLAIMS -MADE U OCCUR MED EXP (Any one person) $ 10 , 0 0 0 A X�GJerieral Liab 34 SBA LJ6557 01/01/2011 01/01/2012.1 PERSONAL& ADV INJURY ( $ 1,000,000 GENERAL AGGREGATE IS 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: FU I POLICY I X I JE LOC T $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $I 1,000,000 $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ A SCHEDULED AUTOS 34 SBA LJ6557 of/D1/zou PROPERTY DAMAGE of/ol/zolz (Per accident) X HIRED AUTOS X S NON -OWNED AUTOS $ UMBRELLA LIAB I j OCCUR I EACH OCCURRENCE $ AGGREGATE $ ( EXCESS LIAR I CLAIMS -MADE l r I DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION WC STATU- IOTH- TORY LIMITS ER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER.IEXECUTIVE[—, 1. E.L. EACH ACCIDENT $ E.L. DISEASE - EAEMPLOYEE1 $ OFFICER/MEMBER EXCLUDED? r/i+ (Mandatory In NH) If yes, describe tinder E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Those usual to the insured's operations. ChKIIt-ICAIt ftULUtK _ %-AIV%,CLLAIIVIV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED City of Fort Collins BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE Attn : Jan Elliott DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 256 W. Mountain Avenue Fort Collins, CO 80521 AUTHORIZE PRESENTATIVE la-z- - i utsts-zuvw At umu L vnrvnA I lviY, All t1y1RD ICACI VCU. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD PBX EVIDENCE OF PROPERTY INSURANCE R045 DATEIMM/DD/ 11-10-201010 THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST. AGENCY PHONE COMPANY lA/C, Nn,ExU: 866) 467-8730 - - - VAN GILDER INSURANCE CORP/PHS. Hartford Casualty Ins Co P 0 BOX 33015 SAN_ANTONIO TX 78265 CODE: 341438 SUB CODE: AGENCY CUSTOMER ID #: INSURED BOULDER DESIGN ALLIANCE ROB DEKIEFFER 3002 MELISSA LANE BOULDER CO 80301 rmurtmi Y wirVI' mAI IVIV LOCATION/DESCRIPTION Location: 1, Building: 1 CONSULTANT - NOC 3002 MELISSA LANE BOULDER CO 80301-4841 LOAN NUMBER POLICY NUMBER 34 SBA LJ6557 EFFECTIVE DATE EXPIRATION DATE CONTINUED UNTIL 01 / 01 / 2 011 0 1/ 0 1/ 2 0 12 7 TERMINATED IF CHECKED THIS REPLACES PRIOR EVIDENCE DATED: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOT WITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS EVIDENCE OF PROPERTY INSURANCE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. rn\/FRArr INFr1RMATl0N - COVERAGE/PERILS/FORMS AMOUNT OFINSURANCE DEDUCTIBLE Policy Coverages: - - Special Form Including Theft Business Income with Extra Expense Equipment Breakdown Coverage Location Level Coverages: Business Personal Property - Replacement Cost $22,200 $500 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUUI I IL)NAL IN I tNtJ I NAME AND ADDRESS MORTGAGEE ADDITIONAL INSURED - W LOSS PAYEE City of Fort Collins LOAN# Attn: Jan Elliott 2 5 6 W . Mountain Avenue AUTHORIZED REPRESENTATIVE Fort Collins, CO 80521 7a-7 ACORD 27 (2009112) ® 1993-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD