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HomeMy WebLinkAbout132158 CTL/THOMPSON INC - INSURANCE CERTIFICATE (12)AC<N?O® CERTIFICATE OF LIABILITY INSURANCE DATE (mm/oo YYrY) Ill s/28/2012 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 NTA T NAME: Van Gilder Insurance Corp. IAInEK1:303-837-8500 FAX Ne:303-831-5295 1515 Wynkoop, Suite 200 EWAIL Denver CO 80202 ADDRESS: INSURERS) AFFORDING COVERAGE NAIC N L1 INSURER A:Pjnnacol Assurance INSURED INSURER B:Lexin ton Insurance Com an A 19437 INSURER C:Travelers Indemnity Co CTUThompson, Inc. INSURER D:Travelers Insurance 1971 W. 12th Ave' Denver CO 80204 INSURER E : ' INSURER F : COVERAGES CERTIFICATE NUMBER: 813334400 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 rypE OF INSURANCE INSVD R SUER MIND POLICY NUMBER POLICY I MM/DD/YYYY POLICY ILIMITS MMIDD/YYYY C GENERAL LIABILITY Y Y 802C991762 10/1/2012 0/1/2013 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMSMADEOCCUR DAMAGE IV RENTED PREMISES Eaoccurrence1 $1,000,000 MED I(Any one person) $10,000 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $2,000,000 IFCT POLICY X PRO- LOC $ D AUTOMOBILE LIABILITY Y Y 8101175R522 10/1/2012 0/1/2013 Ea accident $1,000,000 %( BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ - X PROPERTY DAMAGE (Per accident) $ NON -OWNED HIRED AUTOS X AUTOS C X UMBRELLA LIAB X OCCUR Y Y CUP003CO02974 10/l/2012 0/1/2013 EACH OCCURRENCE $8,000,000 AGGREGATE $8,000,000 EXCESS LIAB CLAIMS -MADE DED X I RETENTION$10000 $ A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN y 618052 10/1/2012 0/l/2013 X I WC STATU- II rTH- TORYLIMITS R .L ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICERIMEMBER EXCLUDED' NIA E L EACH ACCIDENT $500,000 EL. DISEASE - I EMPLOYEE $500,000 (Mandatory in NH) If yee, deacdhe under DESCRIPTION OF OPERATIONS below EL. DISEASE -POLICY LIMIT $500,000 B Professional and 15449004 110/l/2012 0/1/2013 Per Claim $2,000,000 Pollution Liability Annual Aggregate $4,000,000 Claims Made DESCRIPTION OF OPERATIONS I 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... City of Ft. Collins; Purchasing Division P.O. 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. AUTHORREPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: A� ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Van Gilder Insurance Corp. NAMEDINSURED CTL/Thompson,Inc. 1971 W. 12th Ave. Denver CO 80204 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: 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 Ft. Collins, Purchasing Division AL;VKU 1U1 (LUMS/0) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD