HomeMy WebLinkAbout280698 NORTHSTAR DESIGN - INSURANCE CERTIFICATE (3)CERTIFICATE OF LIABILITY INSURANCE
1 02-16/-20111
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).
PRODUCER
POINTS WEST INSURANCE/PHS
344653 P: (866)467-8730 F: (877)905-0457
CON AC
NAME:
ONIE FAx
ArC,NoE.t): (866)467-8730 (A/C,No): (877)905-045
P 0 BOX 33015
ADDRESS:
PRODUCER
SAN ANTONIO TX 78265
CUSTOMER ID#:
INSURERS) AFFORDING COVERAGE
NAIC #
INSURED DLQI
INSURERA: Hartford Casualty IRS Co
INSURER B:
NORTHSTAR DESIGN
700 AUTOMATION DR UNIT I
INSURER C:
WINDSOR CO 80550
INSURER D:
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER: 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.
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I TYPE OF INSURANCE
IINSR
I WVD
POLICY NUMBER
(MM/DD/YYYY)
I (MM/DD/YYYYI
LIMITS
A
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
I CLAIMS -MADE I X I OCCUR
X General Liab
-
34 SBA NF8434
04/13/2011
04/13/2012
EACH OCCURRENCE
$ 1,000,000
PREMISES (Ea occurrence)
$ 300,000
MED EXP (Any one person) $ 10,000
1 PERSONAL &ADV INJURY $ 1,000,000
GENERAL AGGREGATE
$ 2, 000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY U JECOT I X LOC
PRODUCTS - COMP/OP AGG
$ 2, 000, 000
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
34 SBA NF8434
04/13/2011
041/13/2012
COMBINED SINGLE LIMIT
(Ea accident)
I$ 1,00o,000
BODILY INJURY (Per person)
S
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
X
X
$
$
UMBRELLA LIAB OCCUR
EXCESS LIAR CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION $
$
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVEE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
Ni
TWOSTATU- OTH-
I TORV LIMITS I ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE!'$
E.L. DISEASE - POLICY LIMIT 1
$
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101. Additional Remarks Schedule, if more space is required)
Those usual to the Insured's Operations.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
City of Fort Collins
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE
Attn: Purchasing Division
DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZE R PRESENTATIVE
PO BOX 580
Fort Collins CO 80522
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