HomeMy WebLinkAbout315931 BIG THOMPSON WATERSHED FORUM - INSURANCE CERTIFICATE (3)Client#: 41916
BIGTHI
ACOR0. CERTIFICATE OF LIABILITY INSURANCE
DATE(MMMWYYYY)
F
12113/2011
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
Flood & Peterson Ins., Inc.
P. O. Box 578
UUNt
NAME:
_
ACON, Est: g70356-0123 A/CNo9703301867
Greeley, CO 80632
970356-0123
ADDRESS:
CUSTOMER ID A:
INSURERS) AFFORDING COVERAGE
NAICs
INSURED Big Thompson Watershed Forum
800 S Taft Ave
INSURER A: Philadelphia Insurance Companie
INSURER B:
Loveland, CO 80537
INSURER C
INSURER D:
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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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.
INSH
TYPE OF INSURANCE
NDDL
UBR
POLICY NUMBER
MWDD/VYYY
POLICY
IDDNYY
LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LJABIUTY
CIAIMS-MADE. El OCCUR
EACH OCCURRENCE
S
DAMA RENTED
PREMISES Ea occurrence
$
MED EXP (Any one person)
$
PERSONAL& ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE
POUCV
LIMIT APPLIES PER:
PRO- L�
ECTAUTOMOBILE
PRODUCTS - COMP/OP ADD
$
S
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE UMIT
(Ea accident)
$
BODILY INJURY (Par person)
S
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
S
$
UMBRELLA LIAB
EXCESS LIAR
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION
$
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNERIEXECUTIVE❑
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
II yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
WC STATU- OTH-
I FUR U ER
E.L. EACH ACCIDENT
S
E.L. DISEASE - EA EMPLOYEE
$
EL.DISEASE - POLICY LIMIT
$
A
Directors &
Officers Liab
PHSD689777
1/13/2012
01/13/201
$1,000,000/1,000,000
DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, d more space Is required)
Attn: Judy Billica, PhD, PE, Senior Process Engineer & Watershed Manager
City of Fort Collins - Fort SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Collins Water Treatment Facility THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Y ACCORDANCE WITH THE POLICY PROVISIONS.
4316 LaPorte Avenue
Fort Collins, CO 80521 1 AUTHORIZED REPRESENTATIVE
01988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009109) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S661312/M661311 PXP