HomeMy WebLinkAbout286209 BOULDER COUNTY COLORADO - INSURANCE CERTIFICATEAca'Ro� CERTIFICATE OF LIABILITY INSURANCE
DATE 12/30/2010 /YYYY)
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 -
MARSH USA INC.
122517TH STREET, SUITE 2100
CONTACT
NAME:
PHONE (AA/C No):
E-MAIL
DENVER, CO 80202-5534
Attn: Denver.CeNRequest@marsh.com I FAX 212-948-4381
PRODUCER
CUSTOMER ID #:
402252-00124-GAWC-11-12
INSURERS AFFORDING COVERAGE
NAIC p
INSURED
INSURER A ; Insurance Company Of The State Of PA
19429
BOULDER COUNTY COLORADO
202514TH STREET, FIRST FLOOR
INSURER B : N/A
N/A
BOULDER, CO 80306
INSURER C
INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: SEA-001692233-05 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.
INSR
LTR
TYPE OF INSURANCE
ADDL
SUER
POLICY NUMBER
POLICY EFF
MM/DDlYYYY
POLICY EXP
MM/DD% YYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE F—IOCCUR
X $250,000 SIR
37723018
I
01/01/2011
01/01/2012
EACH OCCURRENCE
$ INCLUDED
DAMAGE TO RENTED
PREMISES Ea occurrence
$ INCLUDED
MED EXP (Any one person)
$ NONE
PERSONAL & ADV INJURY
$ INCLUDED
GENERAL AGGREGATE
$ 7,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X I POLICY PRO- LOC
JPCT
PRODUCTS - COMP/OP AGG
$ 7,000,000
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS •
HIRED AUTOS
NON -OWNED AUTOS
-
_
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION $
$
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
WC STATU- TOTH-
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYE
$
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED AS THEIR INTEREST MAY APPEAR TO THE GENERAL LIABILITY POLICY.
rE
CITY OF FORT COLLINS
ATTN: PURCHASING DIVISION
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
of Marsh USA Inc.
Sharon A. Hammer �✓�u Q - �N �E
@ 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD