HomeMy WebLinkAboutREYNOLDS TIERDAEL - INSURANCE CERTIFICATE (2)III CERTIFICATE OF LIABILITY INSURANCE
`,� 5/I/zolz
DATE
/25/2 D/r1
4/25/2011
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 endorsement(s).
PRODUCER Lockton Companies, LLC-1 Kansas City
444 W. 47th Street, Suite 900
Kansas Cityy MO 64112-1906
(816) 960-9000
CONTACT
INC,RM
No EXt : A/C No
E-MAIL
ADDRESS
INSUREEUSI AFFORDING COVERAGE
INSURER A: Old Republic Insurance Com an
24147
INSURED REYNOLDS - TIERDAEL
1054252 1775 EAST 69TH AVENUE
DENVER CO 80229
INSURER B: American Guarantee and Liab. Ins. Co.
26247
INSURER C:
R
INSURER F
COVERAGES T.AYTNOI FK CERTIFICATE NUMBER: 10726004 REVISION NUMBER: XXXXXXX
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
TYPE OF INSURANCE
ADEL
SUBR
POLICY NUMBER
POLICY EFF MMIDDNYYY
MM/OCY EXP DIYYYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE M OCCUR
X CONTRACTUAL
Y
N
MWZY 59151
5/1/2011
5/1/2012
EACH
OCCURRENCE
2 000 000
PREM
GET Ea RENTED
500 000
MED EXP (Any one erson
10000
PERSONAL a ADV INJURY
$ 2,000,000
GENERAL AGGREGATE
s 5,000,000
GEN'L AGGREGATE LIMIT APPLIES PER.
X POLICYPRO- LOC
PRODUCTS -COMP/OP AGG
s 5,000,000
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
AUTOS NED S
OUTOS
S X CHEDULED
HIREDAUTONO OSWNED
N
N
MWTB 21277
5/12011
5/1/2012
Ee eBBINNED SINGLE LIMIT
s 2,000,000
X
BODILY INJURY (Per person)
$ XXXXXXX
BODILY INJURY (Per accident
$ XXXXXXX
X
PROP.E.RI nDAMAGE
$ XXXXXXX
$ XXXXXXX
B
X
UMBRELLA LAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
N
N
3807886-07
5/1/2011
5/1/2012
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1 000 000
DED RETENTION$0
S XXXXXXX
A
A
WORKERS COMPENSATION
AND EMPLOERS'LABILIITY
ANY PROPRIETORIPARTNERE EOUTIVE YIN
OFFICEPoMEMBER EXCLUDED?
(Mandstoryin NH)
DESCRIPTION OF OPERATIONSheow
NIA
N
MWC 11701600
STOPGAP(ND,OH,WA,WV,W
5/1/2011
5/1/2011
5/1/2012
5/I/2012
XTNRVLIMIT OTH
EL EACH ACCIDENT
$ 5000000
E.L. DISEASE -EA EMPLOYEE
5,000,000
ELDISEASE -POLICY LIMIT
sSOOO OOO
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES /(Attach ACORD 101, Additional Remarks Schedule, if more space is required)
CITY OF FORT COLLINS, COLORADO IS AN ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY COVERAGE, ONLY AS REQUIRED
BY CONTRACT, SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY.
10726004
CITY OF FORT COLLINS, COLORADO
4316 LAPORTE AVE.
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.
ACORD 25 (2010/05)
The ACORD name and logo are registered marks of ACORD