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Home My WebLink AboutFRONT RANGE INSTITUTE OF SAFETY (MARK ROSOFF) - INSURANCE CERTIFICATEtE�!W CERTIFICATE OF LIABILITY INSURANCE OP ID DA DATE(MMDDYYYY) 07 z7 1z 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 IEA/C. P.Exl: (AIC. No): Blown & Blown Inc ADDRESS: 4532 Boardwalk Dr, Suite 200 Fort Collins CO 80525 -PRDD CUSTOMER ID q: FRIN$-1 Phone:970-482-7747 Fax:970-484-4165 INSURER(S) AFFORDING COVERAGE NAICN INSURED INSURER A: Scottsdale Insurance Company 41297 Mark Rosoff dba: Front Range Institute of INSURER B: Yarminstou casualty company 41483 INSURER C Safetyy 1437 Summitview Drive INSURER D: Ft Collins CO 80524 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. INSR LTR TYPE OF INSURANCE D INSR MO POLICY NUMBER POLICY EFF (MM/DDNYYY) TDYE (MMIDD/VYVY) LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR X - CPS1604548 06/27/12 06/27/13 EACH OCCURRENCE $ 1,000,000 PREMISESNTED(Ea�cnce S 100,000 MED EXP (Any one person) $Excluded PERSONAL& ADV INJURY s1,000,000 X Prof Liab $1,000, GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ROT POLICY PRO- LOC PRODUCTS - COMP/OP AGO $Excluded $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident( $ $ $ UMBRELLA LIAR EXCESS L IHCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION 3 g $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOILPARTNER/EXECUTIVE❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) f yes, describe under DESCRIPTION OF OPERATIONS below NIA IFUB9686C28Al2 01/25/12 01/25/13 X - " TORY LIMITS ER E.L. EACH ACCIDENT $100,000 E.L. DISEASE - EA EMPLOYEE $ 10 0 , 000 EL.DISEASE - POLICY LIMIT $500,000 Commercial Applica DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES Attach ACORD 101, Additional Remarkre s Schedule, N mom space is required) Instruction in First Aid & C)?R City of Fort Collins is included as Additional Insµred on the General Liability as respects the operations of the named insured. CERTIFICATE HOLDER CANCELLATION City of Fort Collins 215 N. Mason St. Fort Collins CO 8052 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITYFl O I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD