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HomeMy WebLinkAbout286209 BOULDER COUNTY COLORADO - INSURANCE CERTIFICATE (2)CERTIFICATE OF LIABILITY INSURANCE DATE tMh1/DD YYVY) lvzanon 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 CONTACT NAME: MARSH USA INC. PHONE FAX AINC.No: 122517 FIT STREET, SUITE 2100 DENVER, CO 80202-5534 E-MAIL Attn: Denver.CeDRequestgmarsncom I FAX 212 948-4381 ADDRESS: INSURERS AFFORDING COVERAGE NAIC a INSURER A: Insurance Company Of The Stale Of PA 19429100 402252-13C GAW-12-13 INSURED BOULDER COUNTY COLORADO INSURER B; NIA NIA INSURER C : ATTN: MS. PAM STONECIPHER 2025 14TH STREET, FIRST FLOOR BOULDER, CO 80306 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: SEA 002172155 07 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF fMWDDMYYI POLICY EXP (MWDDNYYY)LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F-IOCCUR X $250,000SIR 37723018 01/01/2012 01/0112013 EACH OCCURRENCE $ INCLUDED DAMAGE T REN D PREMISE Eaoccurrence) $ INCLUDED MED EXP (Ary one person) $ NONE PERSONAL& ADV INJURY $ INCLUDED GENERAL AGGREGATE $ 7,000,000 GENT AGGREGATE X POLICY LIMIT APPLIES PER: PRO LOC PRODUCTS - COMP/OP AGG S 7.000,000 S AUTOMOBILE LIABILITY ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS NON OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea accitlent BODILY INJURY (Per person) $ BODILY INJURY (Per accitlent ) $ PROPERTY DAMAGE Per accitlent $ UMBRELLA LIAO EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE S DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) II y dou'ibe antler DESCRIPTION OF OPERATIONS below N/A I WC STAT41 OTH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Sclgdule, if more space is m0uired) CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED AS THEIR INTEREST MAY APPEAR TO THE GENERAL LIABILITY POLICY. CITY OF FORT COLLINS ATTN: PURCHASING DIVISION 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. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Sharon A. Hammer CZ - w w © 1988-2010 ACORD CORPORATION_ All rinhte ,P%ao and ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD