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HomeMy WebLinkAbout102722 JUPITER I LLC DBA OFFICESCAPES - INSURANCE CERTIFICATEACORO® CERTIFICATE OF LIABILITY INSURANCE OATEIMMI00 YYYV) 3 2 2011 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 endorsements . PRODUCER TACT NAME:Account Manager Van Gilder IriSllrariCe Corp. PHONE FAX 1515 Wynkoop, Suite 200 Ex : 0 - 7- 0 AIC No: 03-831- 2 95 EMAIL Denver CO 80202 ADDREss:certificateQygic com INSURER(S) AFFORDING COVERAGE NAICN INSURERA:St Paul Traveler INSURED JUPI INSURER B:Hart ford Insurance Company (M INSURER C: Jupiter I, L.L.C. DBA: OfficeScapes 9900 E 51st Avenue INSURER D: Denver, CO 80238 INSURER E : INSURER I: COVERAGES CERTIFICATE NUMBER: 392722944 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 rypE OF INSURANCE ADDL INSR SUBR MO POLICY NUMBE0. POLICY EFF MMIDDIYYY1f) POLICY EXP MMIDDIYYYY LIMITS H GENERAL LIABILITY Y Y 59UENOC2290 /1/2011 /1/2012 OCCURRENCETORRENCE $1, 000, 000 X COMMERCIAL GENERAL LIABILITY - -EACH DAMAGES Ra arr nn PREMISES Ea occurrence $300, 000 CLAIMS -MADE IX I OCCUR M ED I(Any one person) $10, 000 PERSONAL B ADV INJURY $1, 000, 000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMITJECT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000,000 X POLICY PRO- LOG $ B AUTOMOBILE LIABILITY Y Y 59UENOC2299 /1/2011 /1/2012 INED COMBSINGLE LIMIT $1, 000, 000 X BODILY INJURY (Per person) $ ANY AUTO ALL OS AUTOS LED AUTOS AUTOS BODILY INJURY Per accident ( ) $ 11 NON -OWNED HIRED AUTOS X AUTOS PROPERTY DAMAGE Per accident $ A X UMBRELLA LIAR X OCCUR Y Y QK08300790 10/1/2010 /1/2012 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 EXCESS LIAR CLAIMS -MADE DED X RETENTION$ 10, 000 Follows Form $ R WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOWPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? NIA Y 59WEOC2297 �/1/2011 /1/2012 WC STATU- OTH- $ ER E.L. EACH ACCIDENT $1, 000, 000 E.L. DISEASE - EA EMPLOYEE $1, 000, 000 (Mandatory In NH) If yes, descnbe under E.L. DISEASE POLICY LIMIT $1, 000, 000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if 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 is included as Additional Insureds for ongoing and completed operations under General Liability, Automobile Liability, and Umbrella Liability. This insurance will apply on a primary, non-contributory basis. A Blanket Waiver of Subrogation applies for General Liability, Automobile Liability, Umbrella Liability and Workers' Compensation. See Attached... The City of Fort Collins, a Municipal Corporation Attn: Director of Purchasing & Risk Management;PO 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 ACORD 25 (2010/05) ©1 The ACORD name and logo are registered marks of ACORD reserved. AGENCY CUSTOMER ID: JUPI LOC #: ACC L--�- ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Van Gilder Insurance Corp. Jupiter I, L.L.C. DBA: OfficeScapes 9900 E Slst Avenue Denver, CO 80238 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE GATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE tional Insured: The City of Fort Collins, Colorado, a Municipal Corporation, its officers employees ACORD 101 (2008/01) 2008 ACORD CORPORATION. All riahts reserved The ACORD name and logo are registered marks of ACORD