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HomeMy WebLinkAbout439705 BELFORD WATKINS GROUP LLC - INSURANCE CERTIFICATE (12)ACORO® CERTIFICATE OF LIABILITY INSURANCE 7/23/2013 DATEYYYY) 13 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 CONTACT NAME: Nancy Roman AX PNCNE No Extl,303-837-8500 A/C No: 1 -5295 Van Gilder Insurance Corp. 1515 Wynkoop, Suite 200 Denver CO 80202 E-MAIL ADDREss:nroman v ic.com INSURER(S) AFFORDING COVERAGE NAIC It INSURER A:XL Specialty Insurance Co. P7885 INSURED ,�� BELWAT INSURER B:SentinelInsurance Company, Ltd. h1000 INSURER C : Belford Watkins Group, LLC PO Box 1306 Fort Collins CO 80522 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 23263104 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 rypE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/VYYV POLICY EXP MM/DD/YYYV LIMITS B GENERAL LIABILITY Y Y 34SBAPM7802 /8/2013 /8/2014 EACH OCCURRENCE $1,000,000 x COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED PREMISESS RENT occurrence)$1,000,000 CLAIMS -MADE IT] OCCUR MED EXP (Any one person) $10,000 PERSONAL B AOV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $2,000,000 17 POLICY x PRO- LOC $ B AUTOMOBILE LIABILITY Y Y 34SBAPM71102 /812013 /812014 Ea accident $1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED ASCHEDULED AUTOS UTOS BODILY INJURY (Per accident) $ x PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS x AUTOS B X UMBRELLA LIAB X OCCUR Y Y 34SIlAPM7802 /8/2013 /8/2014 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 EXCESS LIAB CLAIMS -MADE DED x RETENTION $10000 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below _ E.L. DISEASE - POLICY LIMIT $ A Professional Liability N Y DPS1707119 /15/2013 /15/2014 $1,000,000 Per Claim Claims Made $1,000,000 Annual Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is 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 and Owner are included as Additional Insureds for ongoing and 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, non-contributory basis. A Blanket Waiver of Subrogation applies for General Liability, Automobile Liability and Umbrella/Excess Liability. Limited Contractual Liability is included. The Umbrella / Excess Liability policy provides excess coverage over the General Liability and Automobile Liability. VCR 1Irll m1C 11VL10CR City of Fort Collins P.O. 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 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD ACiI IIT�® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD YYYV) 7/23/2013 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 NTACT NAME: Nancy RQman Van Gilder Insurance Corp. 1515 Wynkoop, Suite 200 Denver CO 80202 P"C,N-837-8500 FAX No):303-831-5295 E-MAIL ADDREss:nroman(av ic.com INSURERIS) AFFORDING COVERAGE NAIC If INSURERA.-XL SpecIalty Insurance Go. 37885 INSURED BELWAT INSURERB:Sentinel Insurance Company, Ltd. 11000 INSURER C: Belford Watkins Group, LLC PO Box 1306 Fort Collins CO 80522 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1477773695 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 INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYVY POLICY EXP MM/DD/YYYY LIMITS B GENERAL LIABILITY Y Y 34SBAPM7802 /8/2013 /8/2014 EACH OCCURRENCE $1,000,000 x COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1XI OCCUR DAMAGE TO D PREMISES Ea occurrence) 1,000,000 MED EXP (Any one person) $10,000 PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 $ POLICY X PRO- LOC B AUTOMOBILE LIABILITY Y 14SBAPM71102 18/2013 /8/2014 Ea accident $1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ x PROPERTY DAMAGE Per accident $ NON -OWNED HIREDAUTOS x AUTOS 6 rxd UMBRELLA LIAB X OCCUR Y 34SBAPM7802 /8/2014 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 EXCESS LIAB CLAIMS -MADE �/8/2013 DED I x IRETENTION$ 10000 $ WORKERS COMPENSATION WC STATU- TO Y LIMITS OTH- AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNEWEXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Professional Liability N Y DPS9707159 /15/2013 /15/2014 $1,000,000 Per Claim Claims Made $1,000,000 Annual Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is 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 and Owner are included as Additional Insureds for ongoing and 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, non-contributory basis. A Blanket Waiver of Subrogation applies for General Liability, Automobile Liability and Umbrella/Excess Liability. Limited Contractual Liability is included. The Umbrella / Excess Liability policy provides excess coverage over the General Liability See Attached... City of Fort Collins 215 N Mason 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 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: BELWAT LOC #: ACO OOR AGENCY Van Gilder Insurance Corp. POLICY NUMBER CARRIER ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE NAIC CODE NAMED INSURED 3elford Watkins Group, LLC 'O Box 1306 =ort Collins CO 80522 EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE and Automobile Liability. Included as Additional Insured: City of Fort Collins Page 1 of 1 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD