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Home My WebLink AboutIN-SITU INC - INSURANCE CERTIFICATE (2)Client#: 49195 INSIN2 ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDz'YY) 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 Flood & Peterson Ins., Inc. P. O. Box 578 Greeley, CO 80632 970 356-0123 CONTACT NAME: Sandy Schlfferns PHONE 970 266.7107 FAX 970 506-6845 A/C No Ert : AIC, No EMAIL ADDRESS: sandy.schifferns@floodandpeterson.com schifferns@floodandpeterson.com CUSTOMER ID Jr INSIN2 INSURER(S) AFFORDING COVERAGE NAIC 9 INSURED i In -Situ, Inc. 221 E Lincoln Ave Fort Collins, CO 80524 INSURER A: One Beacon America Insurance Co 20621 INSURER BPinnacolAssurance 41190 INSURER cZurich American Insurance Co 16535 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. INSR TYPE OF INSURANCE POLICY NUMBER FF MWDDCY E/YYYY XP POLICY EIYYYY MM/DD LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I OCCUR 7110127690001 9/01/2012 09/0112013 EACHOCCURRENCE $1 OOO 000 PREMISES Ea ocourrrence $500,000 MED EXP (Any one person) $10-OOO PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE POLICY LIMIT APPLIES PER: PRO- JECTLOC PRODUCTS COMP/OP AGG s2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS DOC 7110127690001 09/01/2012 09/0112013 CO BINEDlSINGLE LIMIT $(En1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) S PROPERTY DAMAGE (Per accident) s X X S X $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 7110127690001 9/01/2012 09/0112013 EACH OCCURRENCE s5 000 OOO AGGREGATE $5 00O 000 DEDUCrIBLE RETENTION $ 0 S X $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNEWEXECUTIVEY/N OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, descri0e under DESCRIPTION OF OPERATIONS below NIA 4126084 09/01/2012 09/01/2013 X I WCSTATU- I OTH- IT ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1 000,000 C Other States WC; Employer's Liab. WC463291301 9/0112012 09/011201 $1,000,000 PerAccident; PerEm to ee;Polic Limit DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Fort Collins 300 Laporte Ave Fort Collins, CO 80526 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 (2009/09) 1 Of 1 #S728517/M728509 O 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SLS