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Home My WebLink About264656 OZ ARCHITECTURE OF DENVER - INSURANCE CERTIFICATEACOR& CERTIFICATE OF LIABILITY INSURANCE �./ DATE (MM/DD/YYYY) Fil/16/2010 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 Cor p• 1515 wynkoop, Suite '200 Denver CO 80202 CONTACT NAME: Mable Griest PHONE FAX A_1C No, E"t)-3-03-837_8_50_0.__ ac _lNot-3_Q3_83-1.__.5.2.95 IL ADDRESS: mqriestCaygic.com PRODUCER CUSTOMER ID #: OZARC INSURER(S) AFFORDING COVERAGE NAIC # INSURED OZ architecture of Denver, Inc. 3012 Huron Street INSURER A: Travelers Insurance 0 INSURER B: Hartford Insurance Group 0 INSURER C: Evanston Insurance Company Denver CO 80202 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 861331584 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. IN RI AODLi SUBR1 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD I POLICY NUMBER MM/DDIYYYY MM/DDIYYYY LIMITS A GENERAL LIABILITY Y Y 6805250L363 10/1/2010 10/l/2011 EACH OCCURRENCE $1,000, 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrenceL_ $ 1, 000, 000 MED EXP (Anyone person) $10, 000 CLAIMS -MADE 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 I PRO- n LOC 1 $ A AUTOMOBILE LIABILITY Y Y BA53351,402 10/l/2010 10/1/2011 COMBINED SINGLE LIMIT (Ea accident) $1, 000, 000 X 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 $ A X UMBRELLA LIAR X OCCUR Y Y CUP1111T130 10/1/2010 10/1/2011 EACH OCCURRENCE $4, 000, 000 AGGREGATE $4,000,000 EXCESS LIAB CLAIMS -MADE I DEDUCTIBLE $ $ X RETENTION $10000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N / A Y 34WEGNX4686 10/1/2010 10/1/2011 WC STATU- (OTH- TORY LIMITS ER_ E.L. EACH ACCIDENT $1, 000, 000 E.L. DISEASE - EA EMPLOYE $1, 000, 000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $1, 000,000 C Professional Liability AE820031 ll/1/2010 10/1/2011 Per Claim $2,000,000 Claims Made Annual Aggregate $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it 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: John Stephen 215 North Mason Street 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 AGENCY CUSTOMER ID: OZARC _ LOC #: ACCWLY ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED Van Gilder Insurance Corp. OZ architecture of Denver, Inc. 3012 Huron Street POLICY NUMBER Deriver CO 80202 CARRIER I NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE:CERTIFICATE OF LIABILITY INSURANCE Page 1 of 1 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. Additional Insured: City of Fort Collins and Poudre River Public Library District, 201 Peterson Street, Fort Collins, Co 80S24 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD