HomeMy WebLinkAboutRAND SCOT INC MOBILITY LTD - INSURANCE CERTIFICATE (2)CERTIFICATE OF LIABILITY INSURANCE OP ID DA
DATE(MMDDYYYY)
O1 26 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 FtX
A/ ERI)'. (AIC, No):
Brown & Brown Inc
4532 Boardwalk Dr, Suite 200
Fort Collins CO 80525
AIL
ADDRESS:
CUSTOMERIDN: RANDS-1
Phone:970-482-7747 Fax:970-484-4165
INSURERS) AFFORDING COVERAGE
NAICH
INSURED
INSURER A: Republic Indemnity co of Cx
43753
Rand -Scot Inc & Mobility Ltd
Saratoga Access & Fitness &
INSURER : Federal Insurance Company
20281
INSURER c: Hartford Underwriters Ins co
30104
Resource Medical Systems, Inc.
Joel & Barbara Lerich Indiv.
401 Linden Center Drive
INSURER D:
INSURER E:
Ft Collins CO 80524
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.
IHSRR
TYPE OF INSURANCE
NSR
SUBADD
POLICY NUMBER
POLICY
POLICY EFF
(MM/DDTYYYYI
POLICY EXP
(MMIDDTYYYY)
LIMITS
B
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
X CLAIMS -MADE OCCUR
35818332WCE
35818333WCE
03/17/12
03/17/12
03/17/13
03/17/13
EACH OCCURRENCE
$ 1,000,000
PREMISES (Ed occurrence)s1,000,000
MED EXP(Any one person)
$10,000
PERSONAL &ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY n JECT LOC
PRODUCTS - COMP/OP ADD
$Excluded
$
C
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
34UECTZ5427
01/17/12
01/17/13
COMBINED SINGLE LIMIT
(Ea accident)
1,000, 000
X
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
B
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
79839892
03/17/12
03/17/13
EACH OCCURRENCE
$1,000,000
AGGREGATE
$1,000,000
X I
DEDUCTIBLE
RETENTION $ 0
S
$
A-
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNEWEXECUTIVG�
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
1310930118 -
04/01/11
04/01/12
X TORY LIMITS ER
E.L. EACH ACCIDENT
$1, 000, 000
E.L. DISEASE - EA EMPLOYEE
$ 1, 0 0 0 , 0 0 0
E. L. DISEASE -POLICY LIMIT
$1, 000, 000
C
Product Liability
Retro 1/17/04
35818333WCE
CLAIMS -MADE
03/17/12
03/17/13
Each Occu 2,000,000
Aggregate 2,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more apace is required)
Certificate holder included as additonal insured for general liability.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITYFCB I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Fort Collins AUTHORIZED REPRESENTATIVE
300 LaPorte Ave I ___�
ACORD CORPORATIC" All rights reserved.
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD