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HomeMy WebLinkAbout103009 PORTER INDUSTRIES (NORTHERN COLORADO CLEANI - INSURANCE CERTIFICATEDate: 2/1/2013 Time: 10:28 AM From: Flood and Peterson To: 9702216707 Page: 1 of 3 Hood and Peterson Insurance, Inc. FAX TRANSMITTAL SHEET ATTN: FROM: City of Fort Collins Flood and Peterson Insurance COMPANY: DATE: 2/1/2013 10:24:38 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. Date: 2/1/2013 Time: 10:28 AM From: Flood and Peterson To: 9702216707 r iiiii faaDs PORIN9 Page: 2 of 3 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DYY) 02/01/2013 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. CONTACT NAME: Kelly Beauvais PA/C HONEo 970 266-7121 FAX 970 506-6846 NEz1: (A/C, No): P. O. Box 578 Greeley, CO 80632 970 356-0123 ADDRIESS. Kbeauvais@floodpeterson.com PRODUCER CUSTOMER ID#: INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURER A. Travelers Insurance Company Northern Colorado Cleaning, LLC dba Porter Industries;Maid Clean 5202 Granite Street INSURER B Pinnacol Assurance INSURER C Loveland, CO 80538 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFYTHATTHE 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 630213955731 2/05/2013 02/05/2014 EACH OCCURRENCE $1,0005000 DAMAGE TO RENTED PREMSES(Ea occurrence) $3005000 MED EXP(Any one person) $105000 PERSONAL& ADV INJURY $150005000 GENERAL AGGREGATE $2,000,000 GENL AGGREGATE LIMIT APPLIES PER POLICY X PIFCT RO LOG PRODUCTS-COMP/OP AGO $2,000,000 $ A AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SC HEDU LED AUTOS HIRED AUTOS NONOWNEDAUTOS P810213955731 2/05/2013 02/05/2014 COMBINED S INGLE LIMIT (Ea accident) $1000000 X BO DI LV I NJ URV(Per person) $ BO DI LV I NJ URV(Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMSMADEAGGREGATE PSMCLIP2139557 2/05/2013 02/05/2014 EACH OCCURRENCE $1000000 $150005000 DEDUCTIBLE RETENTION $ $ B 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 4153522 7/01/2012 07/01/201 X T RSTATU YLIT OTH- OLIMITSER EL. EACH ACCIDENT $150005000 E. L. DISEASEEAEMPLOYEE $150005000 EL.DISEASE -POLICY LIMIT $150005000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) RE: 6120 Carpet Maintenance City of Fort Collins is listed as an Additional Insured as their interest may appear as respects General Liability. City of Fort Collins Purchasing Department PO Box 580 Fort Collins, CO 80524 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 01988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD #S762342/M762300 KLB Date: 2/1/2013 Time: 10:28 AM From: Flood and Peterson To: 9702216707 Page: 3 of 3 This page has been left blank intentionally. Clipntlt- iddn5 PnRIN9 ACORU,., CERTIFICATE OF LIABILITY INSURANCE D02/012013ATE YY) 02/01 /2013 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. P. O. Box 578 CONTACT NAME: Kelly Beauvais PHONE g70 266-7121 FAX A/C No Ext : A/C, No : 970 506-6846 E-MAIL Kbeauvais@floodpeterson.com Greeley, CO 80632 970 356-0123 P CUSTOMER ID M: INSURER(S) AFFORDING COVERAGE NAIC e INSURED INSURER A: Travelers Insurance Company Northern Colorado Cleaning, LLC dba Porter Industries;Maid Clean 5202 Granite Street INSURER BPinnacol Assurance INSURER C : Loveland, CO 80538 INSURER D_ INSURER E : INSURER F : i " COVERAGES CERTIFICATE NUMBER: I I REVISION NUMBEFW THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUR AMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER D� PECT 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 LIJIL TYPE OF INSURANCE DDL UBRI POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MWDD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 51OCCUR 630213955731 2/05/2013 02/05/2014 EACH OCCURRENCE $1 000 000 DAMAGE To R PREMISES Ea occurrence $300 000 MED EXP (Anyone person) $10,000 PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO n LOC PRODUCTS - COMP/OP AGG $2,000,000 S A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS P810213955731 2/05/2013 02/05/2014 COMBINED SINGLE LIMIT (Ea accident) $1 000.000 X BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X S A Xi UMBRELLA LIAR IV EXCESS LIAB IOCCUR CLAIMS -MADE PSMCUP2139557 2/05/2013 02/05/2014 EACH OCCURRENCE $1 000 000 AGGREGATE $1,000,000 DEDUCTIBLE RETENTION S $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICERIMEMBER EXCLUDED? ❑ (Mandatory In NH) If Yes, describe under DESCRIPTION OF OPERATIONS below N/A 4153522 7/01/2012 07/01/2013 X I WC STATU- OTH- E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE S1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Fort Collins is listed as an Additional Insured as their interest may appear as respects General Liability. CERTIFICATE HOLDER CANCELLATION City of Fort Collins Custodial Services i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 Fort Collins, CO 80524 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD #S762336/M762300 KLB Client#- 144ns PORIN2 ACOR0., CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 02/01/2013 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. P. O. Box 578 Greeley, CO 80632 970 356-0123 NAME: CONTACT Kelly Beauvais A/C No970 FAX Ext : - A/C, No 970 506-6846 AIL a DRESS: Kbeauvais@floodpeterson.com PRODUCER CUSTOMER ID 8: INSURER(S) AFFORDING COVERAGE NAIC t INSURED INSURER A: Travelers Insurance Company Northern Colorado Cleaning, LLC INSURERS: Pinnacol Assurance dba Porter Industries;Maid Clean 5202 Granite Street INSURER C Loveland, CO 80538 INSU D : - --RER -- 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 L TYPE OF INSURANCE ADDLSUBRI POLICY NUMBER POLICY EFF MM/DDNYYY POLICY EXP MWDD/YYYY LIMITS A GENERAL LIABILITY nCOM MERCIAL GENERAL LIABILITY CLAIMS -MADE I OCCUR 6302B955731 2/05/2013 02/05/201 EACH OCCURRENCE S1 OOO OOO DAMAGE TO RENTED PREMISES Ea occurrence) $300OOO MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY S1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 7X PRO n LOC PRODUCTS - COMP/OP AGG 52,000,000 $ A AUTOMOBILE X LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS I P8102B955731 2/05/2013 02105/2014 COMBINED SINGLE LIMIT (Ea accident) $11000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) S PROPERTY DAMAGE (Per accident) $ X X $ $ A X UMBRELLA LIAB Iv OCCUR EXCESS LIAB CLAIMS -MADE DEDUCTIBLE RETENTION S PSMCUP2B9557 2/05/2013 02/05/2014 EACHOCCURRENCE S1 000000 AGGREGATE S1,000,000 _ S S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITYER ANY PROPRIETOR/PARTNER/EXECUTIVE — OFFICER/MEMBER EXCLUDED? (Mandatory in NH) 0 yes, describe under DESCRIPTION OF OPERATIONS below N/A 4153522 7/01/2012 07/01/201 X WC STATULIM1- OTH- E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT I S1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, U more space is required) CFRTIFICATF Hni nFR CONCFLI OTION City of Fort Collins Car et Maintenancej/V P SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE 01988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD #S762335/M762300 KLB Client#: 14405 PORIN2 ACORD CERTIFICATE OF LIABILITY INSURANCE F DATE( t�1f,I/DD'YYYY) 02/01 /2013 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 fJA61EACT Kelly Beauvais Flood & Peterson Ins., Inc. PHoIJE 970 266-7121 FAX 970 506-6846 (A/C. No. Ext): (A/C. No): P. O. Box 578 ao AIL Kbeauvais@floodpeterson.com Greeley, CO 80632 -PRODUCER CUSTOt.IER ID =: 970 356-0123 INSURER(S) AFFORDING COVERAGE _ NAIC a INSURED INSURER A: Travelers Insurance Company Northern Colorado Cleaning, LLC dba Porter Industries;Maid Clean 5202 Granite Street Loveland, CO 80538 INSURER B: Pinnacol Assurance INSURER C UISURER 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. NOT%`1ITHSTANDING 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 DDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE NSR VJVD POLICY NUMBER G1 G1/DDlYYYY t.U.1/D DfYYYY LIMITS A GENERAL LIABILITY 6302B955731 02/05/2013 02/05/2014 EACH OCCURRENCE S1,000,000 . X CO".IERCIAL GENERAL LIABILITY DA:'AGE TO RENTED 1 PRE'.IISES (E oc_urrerc<I S 300,000 Slum _ CLAI'.'S-!.!;,DE XOCCUR I t.'ED EXP (Any on; Fer,:ni PERSONAL & ADV INJURY 51,000,000 GENERAL AGGREGATE S2,000,000 GEN L AGGREGATE LI'.IIT APPLIES PER PRODUCTS - COI.'P OP AGG 52,000,000 POLICY X PRO LOC S A AUTOMOBILE LIABILITY P8102B955731 02/05/2013 02/05/2014 Co]1BINED SINGLE a .',T Ina acu�m -1 000,000 X ANY AUTO ALL OY: NED AUTOS BODILY INJURY (Fer F=rson, S III �'I BODILY INJURY(Pe, acaden<,I S SCHEDJLED AUTOS PROPERTY DA%1AGE X HIRED AUTOS S '.(Per aCo danL X NON OriNED AUTOS I S S A X UMBRELLA LIAB X OCCUR I PSMCLIP2B9557 02/05/20131IO2/05/2014 EACH OCCURRENCE S11000,000 EXCESS LIAB CLAI%'S-L'ADE ', AGGREGATE S1,000,000 -- DEDUCTIBLE -- - I -_- -- I c -- -- --• RETENTION S S B WORKERS COMPENSATION - 4153522 07/01/2012 07/01/2013 X TORVIU! TS OTH AND EId PLOYERS' LIABILITY Y / N ANY PROPRIETOR. PARTNER EXECUTIV❑ E . S1,000,OOO EL EACH ACCIDENT OFFICER, MEr.IBER EXCLUDED N/A (Glandatory in NH) E.L. DISEASE - EA E'.1FLOYEE 51 ,000,000 If yes_ descnueunder DESCRIPTION OF OPERATIONS Le-,. E.L. DISEASE - POLICY L1 .11T 1 51,000,000 (Attach DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES ACORD 101. Additional Remarks Schedule. if more space is required) CERTIFICATE HOLDER CANCELLATION City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building & Permit Dept. ACCORDANCE WITH THE POLICY PROVISIONS. Fossil Ridge Maintenance PO Box 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 01988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD #S762334/M762300 KLB Client#: 14405 PORIN2 ACORD- CERTIFICATE OF LIABILITY INSURANCE DATE DD'YYYY) 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 CONTACTNAFJEKelly Beauvais Flood & Peterson Ins., Inc. PHONENo. FAX <uc. Ext 970 266 7121 (A/c. No): 970 506-6846 : P. O. Box 578 ADDRESS: Kbeauvais@floodpeterson.com Greeley, CO 80632 PRODUCER CUST01.1ER ID a: 970 356-0123 — - INSURER(S) AFFORDING COVERAGE NAIC __ INSURED INSURER A: Travelers Insurance Company Northern Colorado Cleaning, LLC Assurance INSURER BPinnacol dba Porter Industries;Maid Clean 5202 Granite Street INSURER C: Loveland, CO 80538 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 REOUIREPaENT. 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 ADDL SUER POLICY EFF (POLICY EXP LTR TYPE OF INSURANCE N R V/VD POLICY NUMBER Idl1I'D YYYY ! f.1 f.1IDDfYYYY LIMITS A 'GENERAL LIABILITY 6302B955731 02/05/2013102/05/2014 EACH OCCURRENCE '', S1,000,000 X CO'.1L'ERCIAL GENERAL LIABILITY _ I DAMAGERENTED 'I ,300y000 I PREMISESS IEa oaurrer_e. CLAI'.15 "ADE XOCCUR III YED EXP (Any on= p=_rsnnl 4 10,000 PERSONAL & ADV INJURY 51,000,000 _ GENERAL AGGREGATE 52,000,000 GEN L AGGREGATE LII:,IT APPLIES PER. PRODUCTS - CO'.'.P OP AGG 52,000,000 POLICY I X I FRO LOC S A AUTOMOBILE LIABILITY P8102B955731 02/05/2013 02/05/2014 CO.1BINED SINGLE -1 'IT _ Ea a-- ="' 1,000,000 X ANY AUTO BODILY INJURY (Per persCn; 5 ALL O'.7P:ED AUTOS � BODILY INJURY (Pcr asidenh 5 SCHEDULED AUTOS — PROPERTY DA'.1AGE � X'' HIRED AUTOS 1Per ac Cdenb NON 01,7NED AUTOS S S A X UMBRELLA LIAB X OCCUR PSMCUP2B9557 02/05/2013 02/05/2014 EACH OCCURRENCE S11,000,000 EXCESS LIAB CLAI'.'S-.`.'ADE AGGREGATE S1,000,000 _ DEDUCTIBLE l_ S RETENTION S 5 B WORKERS COMPENSATION 4153522 07/01/2012 07/01/2013 X tiYCUS STATOTH- AND EMPLOYERS' LIABILITYER YIN ANY PROPRIETOR PARTNER EXECUTIVE E.L. EACH ACCIDENT S1,000,000 0.=F10ER MEMBER EXCLUDED? � N/A (Mandatory in NH) E.L. DISEASE - EA E1:IPLOYEE 11,000,000 If yes. des.nb= un-r DESCRIPTION OF OPERATIONS E L DISEASE - POLICY LC11T S1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101. Additional Remarks Schedule. if more space is required) City of Fort Collins is listed as Additional Insured as their interest may appear as respects General Liability. City of Fort Collins EPIC Center 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 01988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD #S762337/M762300 KLB