HomeMy WebLinkAbout286209 BOULDER COUNTY COLORADO - INSURANCE CERTIFICATE (3)A� o® CERTIFICATE OF LIABILITY INSURANCE
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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
MARSH USA INC.
122517TH STREET, SUITE 2100
CONTACT
NAME'
PWC, No. Exit HONE A/C No:
E-MAIL
ADDRESS:
DENVER, CO B0202-5534
Attn: DeINer.CertRequesl@mamiLoom I FAX 212 948-4381
INSURER S AFFORDING COVERAGE
NAIC Y
INSURER A: Insurance Company Of The State Of PA
19429
402252-BC-GAW-13-14
INSURED
BOULDER COUNTY COLORADO
INSURER B: NIA
NIA
ATTN: MS. PAM STONECIPHER
INSURER C:
INSURER D:
202514TH STREET, FIRST FLOOR
BOULDER, CO 80306
INSURER E :
INSURER F:
COVERAGES CERTIFICATE NUMBER: SEA-002172155-11 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.
INS,POLICY
LTR
TYPE OF INSURANCE
INgR
WVn SUER
POLICY NUMBER
EFF
fNUArcDNYYY1
MOUCWDOMYYI
LIMBS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIM&MADE MOCCUR
X $250,000SIR
37723018
0110112013
0110112014
EACH OCCURRENCE
$ INCLUDED
PREMISES Ea xgun n
$ INCLUDED
MED EXP Any one person)
$ NONE
PERSONALS ADV INJURY
$ INCLUDED
GENERAL AGGREGATE
$ 7,000,000
GEN'L AGGREGATE
_X1 POLICY
LIMIT APPLIES PER:
PRO- LOC
PRODUCTS -COMP/OP AGO
$ 7,000,000
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIREDAUTOS AUTOS
COMBINED SINGLE LIMIT
(Eg accident)
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)$
PROPERTY DAMAGE
Pereccidenl
$
$
UMBRELLA LMB
EXCESS Us
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DED I I RETENTION
$
WORKERS COMPENSATION
AND EMPLOYERVUABIUW YIN
ANV PROPRIETOWPARTNER/EXECUTIVE
OFFICEWMEMBER EXCLUDED?
(Mandatory in NN)
II yyes. tlescree antler
DESCRIPTIONOFiOPERATIONSWlow
N/A
WC STATU OTH-
E.L. EACH ACCIDENT
E
E.L. DISEASE - EA EMPLOYE
$
E.L. DISEASE -POLICY LIMIT
$
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ANach ACORD 101, AddiOonM Remerlu Schedule, B more space is required)
CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED AS THEIR INTEREST MAY APPEAR TO THE GENERAL LIABILITY POLICY.
CITY OF FORT COLLINS
ATTN: 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
of Marsh USA Inc.
Sharon A. Hammer <20'R� a-d✓�
®1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD