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Home My WebLink About107133 BATH INC - INSURANCE CERTIFICATEFAX TRANSMITTAL SHEET ATTN: FROM: City of Fort Collins Flood and Peterson Insurance COMPANY: DATE: 10/31/2012 9:56:58 AM FAX NUMBER: SENDER FAX NUMBER: 9702216707 (970)330-1867 # OF PAGES INC. COVER: SENDER PHONE NUMBER: 3 (970) 356-0123 NOTES/COMMENTS: Please see attached documents The contents of this message sent from Flood & Peterson Insurance, Inc. is confidential, possibly privileged, and intended only for its addressee. If you have received this message in error, you must not disclose, copy, circulate, or in any other way use or rely on the information contained in this message. If you have received this message in error, please contact Flood & Peterson Insurance, Inc. by phone at 970-356-0123. Client#: 21043 BATIN ACORDTM CERTIFICATE OF LIABILITY INSURANCE DYY) 10/31/2012 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 endorsement(s). PRODUCER Flood & Peterson Ins., Inc. CONTACTJennifer Winter NAME: PA/C HONEo 970 506-3206 FAX 970 506-6846 NEz1: (A/C, No): P. O. Box 578 Greeley, CO 80632 970 356-0123 E-MAIL Jennifer.Winter@floodandpeterson.com PRODUCER CUSTOMER ID#: INSURER(S) AFFORDING COVERAGE NAIC# INSURED Bath, Inc. 2000 E. Prospect Road Fort Collins, CO 80525 INSURER A. Bituminous Insurance INSURER B : Travelers Insurance Company INSURER C Pinnacol Assurance 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 LTR TYPE OF INSURANCE %DDI_3LBR NSR NVD POLICY NUMBER POLICY EFF MM/DD/VVVV POLICY EXP MM/DD/VVVV LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMSMADE4OCCUR X PD Ded:500 CLP3578776 11/01/2012 11/01/2013 EACH OCCURRENCE $1,0005000 DAMAGE TO RENTED PREMSES(Ea occurrence) $1005000 MED EXP(Any one person) $105000 PERSONAL &ADV INJURY $150005000 GENERAL AGGREGATE $2,000,000 GENL AGGREGATE LIMIT APPLIES PER POLICY X PIFCTRO X LOG PRODUCTS-COMP/OP AGO $2,000,000 $ A AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SC HEDU LED AUTOS HIRED AUTOS NONOWNEDAUTOS Drive Other Car CAP3578777 11/01/2012 11/01/2013 COMBINED S INGLE LIMIT (Ea accldent) $1000000 X BO DI LV I NJ URV(Per person) $ BO DI LV I NJ URV(Per accident) $ PROPERTY DAMAGE (Per accldent) $ X X $ X $ A B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMSMADEAGGREGATE CUP2800498 ZUP13T9187712NF 0 Retention 11/01/2012 11/01/2012 11/01/2013 11/01/2013 EACH OCCURRENCE $150005000 X1 $150005000 DEDUCTIBLE RETENTION 10000 Each Occur $4,000,000 X A re ate s4,000,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITYYIN ANY PROPRIETOR/PARTNER/EXECUTIVE 7 OFFICER/MEMBER EXCLUDED' (Mandatory in NH) 1 yes, describe under DESCRIPTION OF OPERATIONS below N/A 4015110 11/01/2012 11 /01/201 X WC STATU- OTH- TORV LIMITS ER EL. EACH ACCIDENT $150005000 E. L. DISEASEEAEMPLOYEE $150005000 SEASE-POLICY LIMIT $150005000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) RE: Discovery Mueseum Landscaping City of Fort Collins, its officers, agents and employees, are listed as Additional Insureds as their (See Attached Descriptions) City of Fort Collins Purchasing Division 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 �eF.rera�lL� ACORD 25 (2009/09) 1 of 2 #S745387/M745373 01988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JZS Page interest may appear as respects General Liability, including completed operations. Insurance is primary and non-contributory. AMS 25.3 (2009/09) 2 Of 2 #5745387/M745373