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Home My WebLink About264656 OZ ARCHITECTURE OF DENVER INC - INSURANCE CERTIFICATEACORO® CERTIFICATE OF LIABILITY INSURANCE DATE2012(MM/DDIVYYY) F1 0/1 / 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 endorsements . PRODUCER CONTACT NAME: Van Gilder Insurance Corp. 1515 Wynkoop, Suite 200 Denver CO 80202 PHONE - 37-8500 31-5295 EAMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# 1t INSURER A:Travelers Insurance V INSURED INSURERB:Hartfor_d Insurance GFou '914 OZ Architecture of Denver, Inc. 3003 Larimer St. Denver CO 80205 INSURERC:Eyanston Insurance Company INSURER 0 : INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 530485376 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 rypE OF INSURANCE ADDIISOBR POLICY EFF POLICY E%P LTR INSR WVp POLICY NUMBER MMIDDIYYYY MMIDD1YYYY LIMITS A GENERAL LIABILITY Y Y 6805250L363 10/1/2012 0/l/2013 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence,$1,000,000 MEO 'Any one Person) $10,000 'ERSONALB ADVINJURV $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/OP AGG $2.000,000 POLICY I^ PRO LOC $ A AUTOMOBILE LIABILITY Y Y BA111IL402 10/1/2012 '10/1/2013 Ea acddem $1,000,000 X BODILY I NJ DRY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS X AUTOS A X UMBRELLALIAB X OCCUR Y Y CUP3391T130 10/1/2012 110/1/2013 EACH OCCURRENCE $4,000,000 AGGREGATE $4,000,000 EXCESS LIAB CLAIMS -MADE DED IX I RETENTION$10,000 $ g WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A y 34WEGNX4686 10/1/2012 0/1/2013 X WC STATU- OTH- TORV M T ER $1.000,000 E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYE $1,000,000 (Mandatoryin NH) If yes, describe eerie, E. L. DISEASEPOLICYLIMIT $1,000,000 DESCRIPTION OF OPERATIONS below C Professional Liability E822303 10/1/2012 0/1/2013 Per Claim $2,000,000 Claims Made Annual Aggregate $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) As required by written contract or written agreement, the following provisions apply subject to the policy terms, conditions, limitations and exclusions: The Certificate Holder and Owner are included as Additional Insureds for ongoing and completed operations under General Liability; Designated Insured under Automobile Liability; and Additional Insured under Umbrella / Excess Liability but only with respect to liability arising out of the Named Insured's work performed on behalf of the certificate holder and owner. This insurance will apply on a primary, non-contributory basis. A Blanket Waiver of Subrogation applies for General Liability, Automobile Liability, Umbrella/Excess Liability and Workers' Compensation. Limited Contractual Liability is included. The Umbrella / Excess Liability policy provides excess coverage over See Attached... NULLICK City of Fort Collins Attn:John Stephen 215 North Mason Street 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 ' �T REPRESENTATIVE ACORD 25 (2010/05) U 1Bt5t5-ZU1U ACOKU CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC M A4C"R ® ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Van Gilder Insurance Corp. NAMED INSURED OZ Architecture of Denver, Inc. 3003 Larimer St. Denver CO 80205 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE General Liability, Automobile Liability and Employers Liability. itional Insured: City of Fort Collins and Poudre River Public Library District, 201 Peterson Street, Fort Collins, Cc 80524 101 © 2008 ACORD CORPORATION. All riahts resorved The ACORD name and logo are registered marks of ACORD