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HomeMy WebLinkAbout457580 J F SATO & ASSOCIATES INC - INSURANCE CERTIFICATE (3)ACORO® CERTIFICATE OF LIABILITY INSURANCE 12/13/01DATE20102 IYYYY) 2 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 NAME CONTACT Kathy -Star Van Gilder Insurance Corp. 1515 Wynkoop, Suite 200 Denver CO 80202 PHONE IN E.ti7- A/cFAXNq: 1- 2 IUCEwAIL ADDREss:kstar v ic.com INSUREI AFFORDING COVERAGEIs NAIC N INSURER A:Hartford Insurance Group 14 INSURED ui INSURER B:XL Specialty Insurance Co. 37885 INSURER C: J. F. Sato S Associates, Inc. 5878 S. Rapp Street Littleton CO 80120 INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 1755540863 "`- 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 SUER MD POLICY NUMBER POLICY EFF MMIDONYYY POLICY EXP MMIDDIYYYY LIMITS A GENERAL LIABILITY Y Y 34SBWN09598 12/24/2012 2/24/2013 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $300,000 CLAIMS MADEIT] OCCUR MED EXP(Any one person) $10,000 PERSONAL B ADV INJURY $1,000,000 GENERALAGGREGATE $2,000,000 GEN'L AGGREGATE UMITAPPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICYF] PRO F7 LOC $ A AUTOMOBILE LIABILITY V Y 34SBWN09598 12/24/2012 2/24/2013 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 HIREDAUTOS x AUTOS 8 A X UMBRELLA LIAR X OCCUR Y 14SBWN09598 11/24/2012 2/24/2013 EACH OCCURRENCE $4,000,000 AGGREGATE $4,000,000 EXCESS LIAB CLAIMS -MADE DED X RETENTION$ 10,000 1 Is WORKERS COMPENSATION WC OTH- ANo EMPLOYERS' LIABILITY YIN IMIU TL IS ER ANY PROPRIETOWPARTNER/EXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? NIA E.L. EACH ACCIDENT $ E.L. DISEASE- EA EMPLOYE $ (Mandatory, in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT 1 $ B Professional Liability DPR9699696 /18/2012 /18/2013 Per Claim $1,000,000 Claims Made Annual Aggregate $2,000,000 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 is included as Additional Insured for your work, acts or omissions which includes 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 and non-contributory basis. A Blanket Waiver of Subrogation applies for General Liability, Automobile Liability, Umbrella/Excess Liability and Workers Compensation. The Umbrella / Excess Liability policy provides excess coverage over the General Liability, Automobile See Attached... lei3Ct1 IlIal[L"11 I�10!1 YFI C1 City of Fort Collins, Purchasing 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. AUTHORREPRESENTATIVE All rights reserved ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: AFRO® ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Van Gilder Insurance Corp. NAMED INSURED J.F. Sato & Associates, Inc. 5878 S. Rapp Street Littleton CO 80120 POLJCY 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 .lability and Employers Liability. Wditional Insured: City of Fort Collins ACUKD 101 (2005101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD