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HomeMy WebLinkAboutIN-SITU INC - INSURANCE CERTIFICATE (4)Client#: 49195 INSIN2 ACORD.. CERTIFICATE OF LIABILITY INSURANCE D8/3ATE 012(NUM013 YY) 8/3012013 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 I NAME,ACT Sandy Schifferns (PA 970 266-7107 FAX 970 506-6845 AIC No EXt : AIC, No E-MAIL ADDRESSsschifferns@floodpeterson.com : ssc_.00P INSURER(S) AFFORDING COVERAGE NAIC k INSURER A: Atlantic Specialty Insurance Co 27154 INSURED In -Situ, Inc. 221 E Lincoln Ave INSURER B : INSURER C Fort Collins, CO 80524 _ 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 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. ILTR TYPE OF INSURANCE NSRL SUBR MD POLICY NUMBER MM/DDIMYY MM/DDIMYY LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR 7110127690002 9/011201309/01/201 EACH OCCURRENCE $100D000 PREMISES Ea oiivrtOence s5000OO MED EXP(My one person) $10,000 PERSONAL &ADV INJURY $1,000,000 GENERALAGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC JECT PRODUCTS - COMP/OP AGO $2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIREDAUTOSNON-OWNED IX AUTOS XDOC 7110127690002 9/01/2013 09/01/201 COMBINEDSINGLELIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 7110127690002 9/01/2013 09/01/2014 EACH OCCURRENCE s5,000,000 AGGREGATE $5 000 000 DED I X I RETENTION$0 1 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETORIPARTNEWEXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA I 4060411270000 I 9/01/2013 09/01/201 X N/CSTATU- 'OTH- E.L. EACH ACCIDENT $1000000 E.L. DISEASE - EA EMPLOYEEI $1,000,000 E.L. DISEASE -POLICY LIMIT $1,000,000 A Other States WC Employer's Liab 4060411270000 9/01/2013 09/01/2014 $1,000,000 PerAccident; PerEmployee;PolicyLimit DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) City of Fort Collins 300 Laporte Ave Fort Collins, CO 80526 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 ACORD 25 (2010/05) 1 of 1 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD