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HomeMy WebLinkAboutLARIMER HUMANE SOCIETY DBA LARIMER ANIMAL - INSURANCE CERTIFICATE"� bP CERTIFICATE OF LIABILITY INSURANCE DATE 6/23/20111 YJ 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(les) 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 endomement(s). PRODUCER CONTACT Shell Sawyer NAME: 1'a 1'6Y PHONE o< (303) 776-5122 yC NoJ: (303)776-5495 First Mainstreet Insurance, LLC 512 4th Avenue ADDRESS 01Y ADDRESSssawyer@firstmainstreet.com P.O. Box 847 PRODUCER MER ID p00015789 TA INSURE BAFFORDING COVERAGE NAIC# Longmont CO 80502 INSURED INSURERA:GLeat American Insurance CO. INSURERBGreat American Assurance Co. Larimer Humane Society, DBA: Larimer Animal INSURER C:Pinnacol Assurance 5137 South College Avenue INSURER D: INSURER E Fort Collins CO 80525 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1162301467 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 TYPEOFINSURANCE ADDL INSR SUBR VWD POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMMO LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY I CLAIMS -MADE 1XI OCCUR AC537377007 /1/2011 /1/2012 DAMAGE TO RENTED PREMI E E $ 100,000 MED EXP (My one Pewn) $ 10,000 PERSONAL A AUV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO $ 2,000,000 X POLICY jECPRO- LOC $ B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS 537377107 /1/2011 /1/2012 COMBINED SINGLE LIMIT (Ea accident) S 1,000,000 BODILY IWURY (Per person) $ BODILY INJURY (Per accidenq 8 X SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (Par accident) $ X NON -OWNED AUTOS Uninsured motorist Bl-single $ 1,000,000 Medical payments $ 5,000 UMBRELLA UAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIM CLAIMS -MADE DEDUCTIBLE $ A RETENTION $ - AC537377007- _ /1/2011 /1/2012 $ C WORKERS COMPENSATION MIDEMPLOYERS'LIABILITY YIN ANY PROPRIETOIYPARTNERIEXECUUVE OFFICETUMEMSER EXCLUDED? ❑ (Mandatory In NH) If yes, deecnbe under DESCRIPTION OF OPERATIONS below N I A 4015370 /1/2011 /1/2012 WC STATU- OTH- LIMITS E.L. EACH ACCIDENT $ 100 000 E.DISEASE-EA EMPLOYE $ 100 000 E.L DISEASE - POLICY LIMIT 1 $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more Space is reaulred) Certificate Holder as Additional Insured as required by written contract per policy form. (970)224-6134 City of Fort Collins Purchasing Department Attn: James O'Neil 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 Sawyer/SHELLYS'Z-` ACORD 25 (2009j09) 1988-2009 ACORD CORPORATION. All rights reserved INJUZb (200909) I ne AU V KU name and logo are registered marks Of AGORU