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HomeMy WebLinkAbout398304 LAUREL HILL GIS INC - INSURANCE CERTIFICATE (2)CERTIFICATE OF LIABILITY INSURANCE 10/2DD3//2012olz 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 CONTACT NAME: Katie Klimek Ewing -Leavitt Insurance Agency PNNCN o EaU: 970.679.7375 FAX "0).866.372.4617 EMAIL ADDRESS: katie-klirnek@leavitt.com 4025 St. Cloud Dr. PRODUCER CUSTOMER ID p00002465 : Suite 100 INSURER(S) AFFORDING COVERAGE NAICM Loveland, CO 80538DA INSURED INSURER A: Assurance Company of America 19305 LAUREL HILL GIS INC. INSURER : Pinnacol Assurance 41190 INSURER : Lloyds of London 15792 307 BROSS ST LONGMONT, CO 80501-5427 INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 12/13 master w/ E&O 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 ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR PPS037S751080210112012 02/01/2013 EACH OCCURRENCE $ 1,000,000 DAMAGET RENTED PREMISES Ea occurrence $ 1 OOO,OOO r MED EXP(Any one person) $ 10,000 PERSONAL 6 ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC JECT PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALLOWNEDAUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accdent) $ PROPERTY DAMAGE (Per accident) $ $ A J( UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE PPS03757510910210112012 0210112013 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 DEDUCTIBLE RETENTION $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN OFFICERIM IE ER EXRTNERJCLI ? ECUTIVEā‘ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below MIA 409179 0410112012 0410112013 X Oar LAMlUs OT ER I E.L. EACH ACCIDENT $ 1, oo0, 0O E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Errors 8, Omissions USUCS2644720121012612012 10126/2013 $1,000,000 each claim $1,000,000 Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION City of Fort Collins Attn: John Stephens PO 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 Katie K1 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD