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HomeMy WebLinkAbout457580 J F SATO & ASSOCIATES INC - INSURANCE CERTIFICATE (4)/ . ® oRo CERTIFICATE OF LIABILITY INSURANCE DATE (MMlDD/VVYYI 1/1A/ 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 JSI Colorado LLC 1515 Wynkoop, Suite 200 Denver CO 80202 I INSURERIS) AFFORDING COVERAGE I NAIC a INSURED G J. F. Sato & Associates, Inc. j�S 0 D 5878 S. Rapp Street Littleton CO 80120 COVERAGES CERTIFICATE NUMBER: 573663360 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. IN$R LSIB TYPE OF INSURANCE JIML U POLICY NUMBER LIMITS GENERAL LIABILITY Y Y SBWPP2160 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY $300,000 DAMAGE TO RENTED PREMISES Ea oaunence CLAIMS -MADE � OCCUR 7GENERAL MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY X PRO- X LOC $ B AUTO MOBILE LIABILITY Y 34SBWPP2160 1/31/2014 /31/2015 (Eaaccident _ BODILY INJURY (Per person) ANY AUTO $ BODILY INJURY (Per accident) ALL OWNED SCHEDULED _ AUTOS AUTOS $ PPROPP�� DAMAGE NOTOSWNED J HIRED AUTOS $ X C IX UMBRELLALIAB X OCCUR Y Y 34SBWPP2160 1/31/2014 /31/2015 EACH OCCURRENCE $8,000.000 AGGREGATE EXCESS LIAla CLAIMS -MADE $8,000,000 DED SIX 1 RETENTION$ 10,000 $ WORKERS COMPENSATION WC STATU-LIS OTH- ER AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE $ E.L. FAC14ACCIDENT OFFICER/MEMBER EXCLUDED? ❑ NIA - (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE S M yes, tlesaibe under DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT $ A Professional Liability R9707837 /18/2013 /18/2014 Per Claim $1,000,000 Claims Made Annual Aggregate $2,000,000 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 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 Liability. The Umbrella / Liability policy provides excess coverage over the General Liability, Automobile Liability and Employers Liability. See Attached... lPl R:e I I a L91 S 41111,41111111 1R d 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. AUTHORIZED REPRESENTATIVE //06� ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: ACC ® ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY USI Colorado LLC NAMED INSURED J. F. Sato & Associates, Inc. 5878 S. Rapp Street Littleton CO 80120 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE sired by written contract or written agreement, the following provisions apply subject to the policy terms, conditions, limitations and Dns: The Certificate Holder and Owner are included as Additional Insureds for ongoing and completed operations under General Designated Insured under Automobile Liability; and Additional Insured under Umbrella / Excess Liability but only with respect to arising out of the Named Insured's work performed on behalf of the certificate holder and owner. This insurance will apply on a non-contributory basis. A Blanket Waiver of Subrogation applies for General Liability, Automobile Liability, Umbrella Liability. Contractual Liability is included. The Umbrella Liability policy provides excess coverage over the General Liability and Automobile Insured: City of Fort Collins ACORD 101 (2008/01 ) CO 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD