HomeMy WebLinkAboutFRONT RANGE INSTITUTE OF SAFETY - INSURANCE CERTIFICATE (3)ACOR� CERTIFICATE OF LIABILITY INSURANCE OPID P6 DATE(MM1DDIYYYY)
O1 19 12
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:
PHONE FAX
AIC, No, Ext : UJC, No):
Blown & Brown Inc
ADDRESS:
4532 Boardwalk Dr, Suite 200
Fort Collins CO 80525
-PRODuc
CUSTOMER ID p: FRINS-1
Phone:970-482-7747 Fax:970-484-4165
INSURER(S) AFFORDING COVERAGE
NAIL If
INSURED
INSURER A: Scottsdale insurance Company
41297
Front Range Institute of
Safetyy Mark Rosoff dba:
INSURER B: sarmington Casualty company
41483
INSURER C:
1437 hi4itview Drive
Ft Collins CO 80524
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 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.
ILTR
TYPE OF INSURANCE
INSR
I WV01
POLICY NUMBER
MWDD/YY
( YY)
POLICY
(MMIDDIVYYY)
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS-MADEOCCUR
X
CPS1413881
06/27/11
06/27/12
EACH OCCURRENCE
$1,000,000
PREMISES( a occcu rrence)
$100,000
MEDEXP(Any one person)
$Excluded
PERSONAL BADVINJURY
$1,000,000
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRO -
POLICY n JECT PRO- r LOC
PRODUCTS - COMPIOP AGG
$Excluded
Prof Liab
$ 1, 000, 000
AUTOMOBILE
LIABILITY
ANY AUTO
AUTOS
SCHEDULED
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea accidenQ
$
BODILY INJURY (Per person)
S
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
UMBRELLA LIAR OCCUR
EXCESS LIAR CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
RRDEDUCTIBLE
ETENTION S
$
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNERIEXECUTIVEM
OFFICERIMEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
IFOB9686C28Al2
01/25/12
01/25/13
I
X
TORY LIMITS ER
E.L. EACH ACCIDENT
$ 100000
E.L. DISEASE - EA EMPLOYEE
$ 10 0 0 0 0
E.L. DISEASE -POLICY LIMIT
$ 500000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES Attach ACORD 101, Additional Remas Schedule. if more space is quired)
Instruction in First Aid & C1?rkre
R
Cit of Fort Collins is included as Additional Inaµred on the General
LiZility as respects the operations of the named insured.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITYF10 I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Fort Collins
215 N. Mason St.
reserved
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD