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HomeMy WebLinkAbout416522 KROLL FACTUAL DATA - INSURANCE CERTIFICATE (3)® A� o CERTIFICATE OF PROPERTY INSURANCE DATE(MwDDIYYYY) 0611212013 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. If this certificate is being prepared for a party who has an insurable interest in the property, do not use this fonn. Use ACORD 27 or ACORD 28. PRODUCER MARSH USA INC. SUITE 400 CONTACT NAME: FAX -UU NE ac No: E-MAIL ADDRESS: 125523RD STREET, N.W. WASHINGTON, DC 20037 PRODUCER CUSIOMERID INSURER 5 AFFORDING COVERAGE NAIC N 9995B4-Alteg-13-14 INSURED 41 ti ✓ Kroll Factual Data INSURER A : Affiliated FM Insurance Company 10014 5200 Hahns Peak Or INSURER B Loveland, CO 80538 INSURER C : INSURER D INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: CLE4003821189-01 REVISION NUMBER: 2 LOCATION OF PREMISES I DESCRIPTION OF PROPERTY (ANach ACORD 101, Add'Rional Remarks Schedule, If more space is required) 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 POLICY NUMBER POLICY EFFECTIVE DATE(MM/DDCTIVE POLICY EXPIRATION DATEY EXPIRATION COVERED PROPERTY LIMITS A X PROPERTY CAUSES OF LOSS DEDUCTIBLES WB630 06MI 013 06/0112014 BUILDING PERSONAL PROPERTY BUSINESS INCOME EXTRA EXPENSE RENTAL VALUE BLANKET BUILDING BLANKET PERS PROP BLANKET BLDG 8 PP $ $ BASIC BUILDING 100.000 X $ 1,000,000 BROAD $ CONTENTS 100,000 X SPECIAL $ EARTHQUAKE $ WIND $ FLOOD X $ 328,919,674 $ $ INLAND MARINE OF LOSS NAMED PERILS TYPE OF POLICY $ CAUSES $ POLICY NUMBER $ CRIME TYPE OF POLICY $ $ BOILER $ MACHINERY I EDUIPMENT BREAKDOWN $ $ SPECIAL CONDITIONS I OTHER COVERAGES (AUach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Atli. City's Director of Purchasing 8 ACCORDANCE WITH THE POLICY PROVISIONS. Risk Management AUTHORIZED REPRESENTATIVE PO Box 580 Fort Collins, CO 80522 of Marsh USA Inc. Manashi Mukhegee-Mn---��- - ----a--- C 1995-2009 ACORD CORPORATION. All rights reserved. ACORD 24 (2009109) The ACORD name and logo are registered marks of ACORD Acoiro CERTIFICATE OF LIABILITY INSURANCE DATE(MMMDNYYY) 06112/2013 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 endomement(s). PRODUCER MARSH USA INC. SUITE 400 CONTACT NAME: PHDNE Fr AX AIC Nol: E-MAIL ADDRESS: 125523RD STREET, N.W. WASHINGTON, DC 20037 INSURERS AFFORDING COVERAGE NAIC k INSURER A: Liberty Mutual Fire Ins Co 23035 999584-KROLL-13-14 INSURED Kroll Factual Data 5200 Hahne Peak Or INSURER B : Liberty Insurance Corporation 42404 INSURER C : NIA NIA INSURER D: Loveland, CO 80538 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: CLE-003821193-06 REVISION NUMBER:4 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 TR OF INSURANCE ADDL�TYPE INSR VIVUBRO POLICY NUMBER EFF MMIDDNYYY MMIDDPOLICY Y EXP IYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [ X I OCCUR TB2611259903023 0&01/2013 06/01/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES LEA occo.ho $ 100,000 MED EXP (Any one person) $ 5,0W PERSONAL S ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- LOC PRODUCTS - COMP/OP AGG $ 2,000,000 Is B AUTOMOBILE LIABILITY X ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS AS7611259903013 06101/2013 06101/2014 COMBINED SINGLE LIMIT Ea accident 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ P¢OPERLen DAMAGE $ UMBRELLA LIAO EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ S B B WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETORIPARTNERIEXEcunvE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) Use, describe under DESCRIPTION OF OPERATIONS below N/A WA761 D259903043(ADS) WC7611259903033(WI) 06/01/2013 06/01/2013 06/01/2014 06101/2014 X WC STnRYTATU- DTH- EL. EACH ACCIDENT Is 1,000,000 E. L. DISEASE- EA EMPLOYE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,0ou'um DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) The City of Fort Collins is included as Additional Insured as required by written contract, but limited to the operations of the Insured under said contract, per the applicable endorsement with respect to the General Liability policy. The City of Fort Collins Attn: Citys Director of Purchasing 8 Risk Management 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. Manashi Mukherjee�.z�---��•-3•�- ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Accombp CERTIFICATE OF LIABILITY INSURANCE DVYY) o6rov2013ATE( z),3 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 endorsemenl(s). PRODUCER CONTACT NAME' MARSH USA INC. PHONE FAX SUITE 400 AIC Na E-MAIL 125523RD STREET, N.W. WASHINGTON, DC 20037 ADDRESS: INSURER $ AFFORDING COVERAGE NAIC e INSURER A: Liberty Mutual Fire Ins Co 23035 999584-KROLL- 13-14 INSURED INSURER B : Liberty Insurance Corporation 42404 Kroll Factual Data INSURER C : NIA NIA 5200 Hahns Peak Dr Loveland, CO 80538 INSURER D INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: CLE-003821193-04 REVISION NUMBER:1 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 ADDL SUBR POLICY NUMBER MMIDDNYICY YYY POLICY EXP MWDD/YYYY LIMITS A GENERAL LIABILITY K COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Ifl OCCUR TB2611259903023 06101/2013 0610112014 EACH OCCURRENCE $ 1,000,000 PREMI ET R NT D PREMISES Eaoccurrence)$ 100,000 MED EXP (Anyone person) $ 5,000 PERSONAL B ADV INJURY $ GENERAL AGGREGATE $ 2.000,E GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY F7 PRO LOC PRODUCTS - COMP/OP AGO 8 2,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS AS7611259903013 0610112013 0610112014 COMBINED SINGLE LIMIT Ea accident 1,000,000 X BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accaent $ IS UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION$ $ B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? � (Manclatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WA761 D259903043(ADS) WC7611259903033 (WI) 06101/2013 06/0112013 0610112114 0610112014 X WC STATU- I I OTH- E. L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE- EA EMPLOYEE $ 1,000,000 E.L.DISEASE - POLICY LIMIT $ 1,000,000 TI I DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of Fat Collins is included as Additional Insured as required by written contact, but limited to the operations of the Insured under said contract, per the applicable endorsement with respect to the General Liability policy. The City of Fan Collins Attn: City's Director of Purchasing & Risk Management 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. Manashi Mukheoee 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD