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HomeMy WebLinkAbout457580 J F SATO & ASSOCIATES INC - INSURANCE CERTIFICATE (5)Ill CERTIFICATE OF LIABILITY INSURANCE DATE(mmm0 rvyvl 7/3/2013 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 endorsements . PRODUCER Van Gilder Insurance Corp. 1515 Wynkoop; Suite 200 Denver CO 80202 CONT CT NAME� Kathy Star PNCNE o. - 7- FAX No: Q3=83_L-52 E-MAIL ADDRESS:I v i INSURERS AFFORDING COVERAGE NAICa INSURER A:Hartforc! Insurance Group P14 INSURED INSURERB:XLSpecialty InSuran CO 3Z885 INSURER c: J. F. Sato & Associates, Inc. 5878 S. Rapp Street Littleton CO 80120 INSURER D : INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 2006623743 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADOLISUBR POLICY EFF POLICY E%P LTN TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIOOIYYYY MM1013 YY LIMITS A GENERAL LIABILITY Y Y '34SBWN09598 2/24/2012 '12/24/2013 EACH OCCURRENCE $1.000.000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Ix I OCCUR AmAGSTC_RENT� PREMISES Ea occurrence $300,000 MED EXP(Any one person) $10.000 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $2,000,000 POLICY X PRO- 7LOG JECT $ A AUTOMOBILE LIABILITY Y Y 34SBWN09598 12/24/201212/24/2013 Ea auiaent $1,000,000 BODILY INJURY( Per person) $ ANY AUTO AOSCHEDULED AUTOS AUTOS BODILY INJURY (Per acGdeni) 8 X HIRED AUTOS X AUTO LAMED FO"c NI DAMAGE $ $ A X UMBRELLA LIAR X OCCUR Y Y 34SBWN09598 12/24/2013 EACH OCCURRENCE $8.000.000 AGGREGATE $8,000,000 EXCESS ICLAIMS-MADE �2/24/2012 DED Ix I RETENTION$ 10,000 I S WORKERS COMPENSATION WG STATUS I OTH- U, AND EMPLOYERS' LIABILITY Y I NDRY E. L. EACH ACCIDENT IS ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? F--]NIA E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) If yes. descnbe under DE SCRIPTION OF OPERATIONSbel. E.L. DISEASE -POLICY LIMIT $ B Professional Liability !DPR9707637 /16/2013 /1B/2014 Per Claim $1000.000 Claims Made Annual Aggregate $2,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, d more apace la 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... 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. AUTHOR REPRESENTATIVE 04. ACORD 25 (2010/05) © 1988-2010 The ACORD name and logo are registered marks of ACORD reserved. AGENCY CUSTOMER ID: LOC #: A� ® 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 POLICY 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 and Employers Liability. al Insured: City of Fort Collins ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All The ACORD name and logo are registered marks of ACORD