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HomeMy WebLinkAbout109315 COLORADO DOORWAYS INC - INSURANCE CERTIFICATE (9)COLOR01 OP ID: DC '4`� CERTIFICATE OF LIABILITY INSURANCE DAT09/01DYYYY) os/ov11 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 INSURERS), 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 303-831-7100 CONTACT NAME: Thomas J. Sisk & Company,Inc. 1700 Broadway, Suits 1000 303-831-7377 PHONE FAX LAIC No Ert: A/C No: Denver, CO 80290 Thomas J. Sisk, Jr. E-MAIL ADDRESS: O INSURERS AFFORDING COVERAGE NAIC Y INSURER A -Peerless Indemnity INSURED Colorado Doorways Inc. Janice Baumgartner 3333 East 52nd Ave INSURERS: PInnacol Assurance INSURER c :Great American Insurance Co. INSURER D Denver, CO 80216-2322 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. INSR LTR OF INSURANCE ADDLTYPE INSR Site. POLICY NUMBER MMIDDIYYYY MMIDDYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I OCCUR CBP7281463 09/01/11 09/01/12 -DAMAGE TO RENT ED— PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMPIOPAGG $ 2,000,000 1-1 POLICY F7 PRO LOG Emp Ben. $ 1,000,000 AUTOMOBILE LIABILITY COMBINED ISINGLE LIMIT $ 1,000,000 X BOD ILY INJ U RV(Per person) $ A ANY AUTO BA7281459 09/01/11 09/01/12 OS AUTOS SCHEDULED ALL UTOS AUTOS AU BODILY INJURY (Per accident I $ NON -OWNED MIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ X UMBRELLALIAB X OCCUR I EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 C EXCESS LIAB CLAIMS -MADE S13U02225400 09/01/11 09/01/12 DED X I RETENTION$ 10000 $ WORKERS COMPENSATION WC STATU- OTH- B AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER,EXECUTIVE YIN OFFICER/MEMSER EXCLUDED? NIA 3142569 09/01/11 09/01/12 T RV M ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE- EA EMPLOYEE1 $ 1,000,000 (Mandatory In NMI It yes, despise under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 A Property Section CBP7281463 09/01/11 09/01/12 A Equipment Floats CBP7281463 09/01/11 09/01/12 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City, its officers, agents and employees are additional insureds. CITYOFF City of Fort Collins Attn: John Stephen PO 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. AUTHORIZEDUT�� � �REPRRESENTATIV E © 1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD