HomeMy WebLinkAbout462625 PEAK LEADERSHIP CONSULTING - INSURANCE CERTIFICATE (2)173147
A� �® CERTIFICATE OF LIABILITY INSURANCE
Dar2/241D/12
2/24/2012
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 pollcy(les) 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 endomement(s).
PRODUCER
CONTACT Linda McLaughlin
NAME: 9
Commercial Lines - (330) 726-8861
PHONE FAX
IAIC..No E.D: 330-729-2632 �aUyeo): 330-726=8997
EMAIL f l l d na.mcau hlin welsar o.com
ADDRESS: Li9 @ 9
Wells Fargo Insurance Services USA, Inc.
8561 Market Street '1'
Youngstown, OH 44512-6727�� y� _
INSURERISI AFFORDING COVERAGE
NAICF
INSURER A I American Casualty Company of Reading, PA
20427
INSURED
INSURER e: Hartford Accident and Indemnity Company
22357
Peak Leadership Consulting
INSURER C :
INSURER D :
4548 Seaway Circle
INSURER E :
__
INSURER F
Fort Collins, CO 80525
COVERAGES CERTIFICATE NUMBER: 5347825 REVISION NUMBER: See below
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE :HSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMEN I, 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 PAIII CLAIM1IS.
INSR TYPE OF INSURANCE AGOLTSUBR POLICY EFF I POLICY Ex" 1 LIMITS
LTR IN DI POLICY NUMBER �IMM/DDNYYYI I�MMIDDIYYYY __
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
X
4030752651
O6/10l'2012
OF/, 0!2013
EACH OCCURRENCE_ _
�-DAATAGET6REW ED
PREMISES JE. uccertonceJ_
$ 1,000,000
$ — 300,000
CLAIMSMADEOCCUR
MED E%P (Any one person)_
r- --
1 PERSONAL X ADV INJURY
5 in, 000
$ 1,000.000
ERAL AGGREGATE_
b 2,000,000
PER'.
GEN'L AGGREGATE OMIT APPLIESCT
DUCTS-COMPIOP AGG
F
$ 200n,n00
X POLICY PRO- LOC
—
$
AUTOMOBILE LIABILITY
I
COMBINED SINGLE LIMIT
-(Enccitleml_--__
1,00n,000
$
BODII V INJURY (Per person)
$
ANY AUTO
$
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident)
PROPERTY DAMAGE
(Per accident)
s
_
A
NON -OWNED
X HIRED AUTOS D AUTOS
X
4030752651
06/10/2012
06/10/2013
UMBRELLA LIAR
OCCUR
EACH OCCURRENCE
$
AGGREGATE
�$
EXCESS LIAR
CLAIMS -MADE
DED I RETENTION$
Is
B
WORKERS COMPENSATION
AND EMPLOYERS'LIASILITY YIN
ANY PROPRIETORIPARTNERIE%ECUUVE
OFFICERIMEMBER EXCLUDED? ❑
(Mandatory in NMI
NIA
45WECVY2321
06/01/2012
06/01/2013
„IWC STA?Il OTH-
_..._AQPsTIM1151____F-R.____—
E L. EACH ACCIDENT
$ 100.000
— —
E.L. DISEASE - EA EMPLOYEE
--—
$ 500,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 100,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD ID1, Additional Remarks Schedule, If more space is required)
SB-146932-D (Ed. 07/09) City of Fort Collins is Additional Insured. Reference form SB300120B 0410.
City of Fort Collins
Attn: 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.
AUTHORIZED REPRESENTATIVE
_ The ACORD name and logo are registered marks of ACORD O 1988.2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) 111111111111111111111111111111111N 1111111111111111111111111111111111111111111111111
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