HomeMy WebLinkAbout501351 WORKSPACE INNOVATIONS LTD - INSURANCE CERTIFICATEOP ID: KE
,d►41ft o CERTIFICATE OF LIABILITY INSURANCE
DAT 08/23/13 )
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 endorsement(s).
PRODUCER 970-223-1604
VolkBell Property 8 Casualty
1100 Haxton Dr. Suite #100
Fort Collins, CO 80525
Kyle $ RehmB
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CONTACTNAME:
PHDNE 970-223-1804 ac Na: 970.225A941
AIC No Ert:
E-MAIL
PRODUCER
CUSTOMERIox:NUGEN-1
INSURE S AFFORDING COVERAGE
NAIC0
INSURED Workspace Innovations, Ltd
4414 E. Harmony Rd, #100
Fort Collins, CO 80527
INSURER A: Pinnacol Assurance
41190
INSURERB:Secura Insurance Companies
22543
INSURER C :
INSURER or
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
LR
TYPE OF INSURANCE
OOL3
VD
POLICY NUMBER
MMIDDNYY
MM/DD//YYYY
LIMITS
B
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE FXI OCCUR
X
CP3153717
09/01/13
09/01114
EACH OCCURRENCE
E 1,000,00
PREMISES Ea occumenre
E 100,00
MED EXP (Any one person)
E 10,00
PERSONAL S ADV INJURY
E 1,000,00
GENERAL AGGREGATE
E 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER.
POLICY X PRO LOG
PRODUCTS - COMPIOP AGG
E 2,000,00
E
B
B
B
AUTOMOBILE
LIABILITY
ANY Auto
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
X
A3153718
A3153718
A3153718
09101113
09101113
09101113
09101114
09/01/14
09/01114
COMBINED SINGLE LIMIT
(Ea amidenq
E 1,000,00
X
BODILY INJURY (Per person)
E
BODILY INJURY (Per accident)
E
PROPERTY DAMAGE
(Per accident)
E
X
X
E
E
B
X
UMBRELLA DAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
CU3170470
09/01113
09/01114
EACH OCCURRENCE
E 1,000,00
rX
AGGREGATE
E 1,000,00
DEDUCTIBLE
RETENTION E 10,000
E
E
A
WORKERS COMPENSATION
ANDEMPLOYERS'UABILITY yIN
ANY PROPRIETORRARTNERIEXECUTNE
OFFICER/MEMBER EXCLUDED? ❑N
(Mandatary in NH)
If yes. desuibe under
DESCRIPTION OF OPERATIONS below
N/A
4129130
OZI01A3
I
02/01/14
' X WC S �Mii OTH-
ER
—
EL EACH ACCIDENT
E 1,000,00
E.L. DISEASE - EA EMPLOYE
E 1,000,00
E.L. DISEASE - POLICY LIMIT I
s 1,000,00
B
Cargo Liability
I
CP3153717
09/01113
09/01114
(Cargo 100,00
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101, AddiUmlal Remarks Schedule, If mom space is required)
City ofFort Collins is named as additional insured. '
CITY OF
City of Fort Collins
Attn: David Carey
215 N. Mason St.
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
n 1QRR.2nnQ ACORn CORP0RATIr)N All rinhts
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD