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HomeMy WebLinkAbout264656 OZ ARCHITECTURE OF DENVER - INSURANCE CERTIFICATE (2)ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYW) 10 4 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 NAME: Van Gilder Insurance Corp. 1515 Wynkoop, Suite 200 Denver CO 80202 PHONE FAX FAIA - - C No: - - 5295 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIL# INSURER A: INSURED INSURER B:HBrtf Ord Insuraj, rou INSURER C:EY.anst9n_Insurance Company OZ Architecture of Denver, Inc. 3003 Larimer St. Denver CO 80205 INSURER D: INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 1108675327 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 LTft I TYPE OF INSURANCE ADDL INSR SUER MD POLICY NUMBER POLICY EFF MMIODili POLICY EXP IMMUDDiffYM LIMITS A GENERAL LIABILITY Y Y 680525OL363 li 0/1/2012 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ea omurrence $1,000,000 NED EXP(Any one person) $30,000 PERSONAL& ADV INJURY $1, coo, coo GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY X PRO- LOC JECT $ A AUTOMOBILE LIABILITY Y Y BA5335L402 10/1/2011 0/1/2012 Ea accident) $1, 000, 000 % BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) b .1 PROPERTY DAMAGE Per accident) $ NON -OWNED HIRED AUTOS X gUT05 8 A X UMBRELLA LIAB X OCCUR y y CUP3391T130 10/1/2011 0/1/2012 EACH OCCURRENCE $4,000,000 AGGREGATE S4,000,000 EXCESSIL CLAIMS -MADE DIED X RETENTION$ 10, 000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETORIPARTNEWEXECUTIVE OFFICEMEMBER EXCLUDED] ❑ N/A y 34WEGNX4686 30/1/2011 �0/1/2012 % WCSTATU- TORYLIMITS ER EL_EACH ACCIDENT $1, 000, 000 E.L. DISEASE - EA EMPLOYE S1,000, 000 ufandatory in NH) If DESCRIPTION OF OPERATIONS Belo+ E L DISEASE -POLICY LIMIT $1, 000, 000 C Professional Liability 821289 0/l/2012 Per Claim $2,000,000 Claims Made �0/1/2011 Annual Aggregate $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more apace 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 and Owner are included as Additional Insureds for ongoing and completed operations under General Liability; Designated Insured under Automobile Liability; and Additional Insured under Umbrella Liability but only with respect to liability arising out of the Named Insured's work performed on behalf of the certificate holder and owner. This insurance will apply on a primary, non-contributory basis. A Blanket Waiver of Subrogation applies for See Attached... City of Fort Collins Attn: John Stephen 215 North Mason Street 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 9)1988-2010 ACORD CORPORATION. All rici ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC k: A o® ADDITIONAL REMARKS SCHEDULE Page I of 1 AGENCY NAMED INSURED Van Gilder Insurance Corp. OZ Architecture of Denver, Inc. 3003 Latimer St. Denver CO 80205 POLICY NUMBER CARRIER NAIL CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE General Liability, Automobile Liability, Umbrella Liability and Workers' Compensation. Limited Contractual Liability is included. The Umbrella iability policy provides excess coverage over the General Liability, Automobile Liability and Employers Liability. Additional Insured: City of Fort Collins and Poudre River Public Library District, 201 Peterson Street, Fort Collins. Co 80524 © 2008 ACORD CORPORATION The ACORD name and logo are registered marks of ACORD