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HomeMy WebLinkAbout102831 LARIMER HUMANE SOCIETY - INSURANCE CERTIFICATEA� �® CERTIFICATE OF LIABILITY INSURANCE DATE 6/29/20112 ) 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 First Mainstreet Insurance, LLC 275 S. Main Street, Suite 100 P.O. BOX 847 Longmont CO 80502 CONTACT Deb Barone NAME: PHONE (303) 776-5122 ac No: (303)776-5495 AEbmpAg'LESS,dbarone@firstmainstreet.com INSURERS AFFORDING COVERAGE NAIC# INSURERA:Great American Insurance Co. INSURED 1 mp Larimer Humane Society 1v)- DBA: Larimer Animal Protection 6 Control 5137 South College Avenue Fort Collins CO 80525 INSURERB:GLeat American Assurance Co. INSURERC:GredIn American Alliance Ins Co INSURER D:Pinnacol Assurance INSURER E: �111]j INSURER F: COVERAGES CERTIFICATE NUMBER:1.2/13 CT, AL UMS WC 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 ADDIESUBR POLICY NUMBER POLICY EFF MMIDDNYYY POLICY EXP MM/DDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 100,000 X COMMERCIAL GENERAL LIABILITY A CLAIMS -MADE ❑X OCCUR PAC537377008 /1/2012 /1/2013 MED EXP(Any one person) S 10,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGO $ 2,000,000 $ X POLICY PRO LOC AUTOMOBLE LIABILITY COMBINED SINGLE LIMIT Ea cc,da.0 $ 1,000,000 BODILY INJURY(Per person) $ B ANY AUTO ALL OWNED SCHEDULED HIJREDSAUTOS AUTOS X AUTOS R 537377108 /1/2012 /1/2013 BODILY INJURY(Per aaident) S PROPERTY DAMAGE Per accident $ Uninsured motorist Bl-sin le S 1 000 000 X N UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 C EXCESS LIA.B CLAIMS -MADE DED X RETENTION$ 10,000 $ P0537377208 /1/2012 /1/2013 D WORKERS COMPENSATION WC STATU- OTH- FR AND EMPLOYER$' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A 015370 /1/2012 ./1/2013 E. L. EACH ACCIDENT $ 100,000 E.L. DISEASE-EAEMPLOYE $ 100 000 EL DISEASE-POLICYLIMIT $ 500,000 If y describe under DE re.OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Certificate Holder as Additional Insured as required by written contract per policy form. (970)224-6134 City of Fort Collins Purchasing Department P 0 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 ACORD 25 (2010/05) INS025 (201005).01 Barone/DBARON X)a,•r./Q6:f?— ©1988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD