HomeMy WebLinkAbout113967 PROJECT SELF-SUFFICIENCY - INSURANCE CERTIFICATE (3)Client#: 35461
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ACORD CERTIFICATE OF LIABILITY INSURANCE
DATE/YYYY)
1 04/25/205/201,
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 tices not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
Flood & Peterson Ins., Inc.
P. O. Box 578
NAME:
PHDNE g70 356-0123 9703301867
A/C No Eat : A/C, No
TC
Greeley, CO 80632
970356-0123
ADDRESS:
CUSTOMER ID N:
INSURER(S) AFFORDING COVERAGE
NAICN
INSURED
INSURER A: The Cincinnati Insurance COmpan
Project Self -Sufficiency of Lvld-Ft Col
375 W. 37th St., Suite 150
Loveland, CO 80538-2261
INSURER B
INSURER C
INSURER 0:
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.
LTIL
TYPE OF INSURANCE
POLICY NUMBER
MM/DDNYF
MVDWYYYY
LIMBS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE FXI OCCUR
CAP5220580
4/25/2011
04/2512012
EACH OCCURRENCE
$1 00O 000
DAMAGE TO REN1ED
PREMISES Ea occurrema
$100000
MED EXP (Any one person)
$10,000
PERSONAL& ADV INJURY
$1,000,000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE
POLICY
LIMIT APPLIES PER:
PRO-LOC
PRODUCTS - COMP/OP AGO
s2000,000
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AU705
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE INGLE OMIT
$ $1,000,000
BODILY INJURY (Per parson)
S
BODILY INJURY (Per accident)
S
PROPERTY DAMAGE
(Per accident)
$
X
X
$
$
UMBRELLA LIAR
EXCESS UAB
CUR
CLAIMS -MADE
CC
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION
$
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
II yes, downed under
DESCRIPTION OF OPERATIONS below
N/A
WCSTATU I OTH-
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASEPOLICYLIMIT
S
A
Garage Liability
CAP5220580
4/25/2011
04/25/201
$1,000,000 Per Accident
$3 000 000 Aggregate
DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORD 101, Addidoml Relne" SchWule, N more spaceis required)
The certificate holder is named as an additional insured as their interest
may appear in reference to the named insured's operations in regards to
(See Attached Descriptions)
City of Fort Collins
P.O. 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
Fl000t r z;kJe.
01988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2DO9/09) 1 Of 2
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The ACORD name and logo are registered marks of ACORD
CXB
DESCRIPTIONS (Continued from. Page 1).
the use of the Repair Shop.
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