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HomeMy WebLinkAbout132158 CTL/THOMPSON INC - INSURANCE CERTIFICATE (13)ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MM DD YY Y1 9/22/2011 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 endorsements . PRODUCER CONTACT NAME: PHOC.NE FIC No :=S29S Van Gilder Insurance Corp. 1515 Wynkoop, Suite 200 E-MAIL Denver CO 80202 ADDRESS: INSURER $ AFFORDING COVERAGE NAIC P INSURER A :Plnnacol Assurance INSURED INSURERB: eXIDgton lnsufaDC�C.o7rlpany_(A CTLrrhompson, Inc. INSURER C ;Hartford Insurance G-Eou 1971 W' 12th Ave. INSURERD: Denver CO 80204 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 695287936 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. NSR I j1AI5b1JSUBR1 I POLICY EFF POLICY E%P LTR TYPE OF INSURANCE IN IWO POLICY NUMBER MMIDD MMIODIYYYY LIMITS C GENERAL LIABILITY Y Y G4UUNEX2070 0/1/2011 10/1/2012 EACH OCCURRENCE $1,000,0ED X COMMERCIAL GENERAL LIABILITY DAMA T RENTED PREMISES Ea accunance $1,000,000 CLAIMS -MADE X❑ OCCUR MED EXP (Any one person) $10,000 PERSONAL B ADV INJURY $1, 000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER'. PRODUCTS-COMP/OP AGG 82,000,000 POLICY F PRO FCT X LOC Deductible $1,000 C AUTOMOBILE LIABILITY Y Y 34UENEX2190 110/1/2011 0/l/2012 Ea accident 1 000 000 X BODILY INJURY (Par person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Perauadenp $ X PHUFtHIY UAMAGE (PeC $ HIREDAUTOs X NONM. ED X UMBRELLA LIAR X OCCUR Y Y 14XHUEX1110 0/1/2011 10/1/2012 EACH OCCURRENCE $8,000.000 E%CESS LIAR (CLAIMS -MADE AGGREGATE $8.000.000 DIED IX I RETENTION$10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN y 18052 10/1/2011 0/1/2012 X WC STATU- OTH- ORV E.L. EACH ACCIDENT $500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE❑ OFFICER/MEMBER EXCLUDED? NIA E.L. DISEASE -EA EMPLOYE $500,000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $500,000 B Professional Liability I015449004 10/1/2011 0/1/2012 Per Claim $2,000.000 Pollution Liability Annual Aggregate $4.000.000 Claims Made DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space 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 / Excess 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 General Liability, Automobile Liability, Umbrella/Excess Liability and Workers' Compensation. Limited Contractual Liability is included. The Umbrella / Excess Liability policy provides excess coverage over See Attached... City of Ft. Collins; Purchasing Division 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 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AC 0® 111./ AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Van Gilder Insurance Corp. NAMED INSURED CTL/Thompson, Inc. 1971 W. 12th Ave. Denver CO 80204 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE General Liability, Automobile Liability and Employers Liability. itional Insured: City of Ft. Collins, Purchasing Division ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD