HomeMy WebLinkAbout129491 FORT COLLINS HOUSING AUTHORITY - INSURANCE CERTIFICATEI�R M CERTIFICATE OF LIABILITY INSURANCE DATE(MM
ouo5/2014YY)
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PRODUCER
Pinnacol Assurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
7501 E Lowry Blvd AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
Denver, CO 80230-7006 CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAICM
INSURED
Fort Collins Housing Authority ' 2/'9-q�
1715 W Mountain Ave
INSURERA: Pinnacol Assurance
41190
INSURER B:
NsuRERc:
Fort Collins, CO 80521 77
INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDNG
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMMENT 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
AODL
POLICY EFFECTIVE
POLICY EXPIRATION
LTR
INSRD
TYPE OF INSURANCE
POLICY NUMBER
DATE(MMIDDIYYYY)
DATE(MMIDD/YYYY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
MED OnAny one non
PERSONAL S ADV INJURY
GEN-L AGGREGATE LIMIT APPLIERS PER:
GENERAL AGGREGATE
PRODUCTS -COMPIOP AGG
POLICY PROJECT LOC
AInOMOBILE LIABILITY
COMBINED SINGLE LIMIT
ANY AUTO
(Ee Accident)
BODILY INJURY
ALL OWNED AUTOS
SCHEDULED AUTOS
Per non
HIRED AUTOS
BODILY INJURY
NON -OWNED AUTOS
Per scc ent
PROPERTY DAMAGE
(Per eccYlaA)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
OTHER THAN EA ACC
ANY AUTO
AUTO ONLY:
EXCESSAIYBRELLA LIMMIM
OCCUR CLAIMS MADE
EACH OCCURRENCE
AGGREGATE
DEDUCTIBLE
RETENTION S
WORKERS COMPENSATION AND
WC STATU- OTHER
Ll
A
EMPLOYER'S LIABILITY
ANY PROPRIETOR/
OFFICERIMEMBER EXCLUDED?
13a5762
01/01/2014
01/01/2015
S
LEArMAACCPARTNERIEXECUTIVE
E.L EACCCIDENT
$100,000
E.L DISEASE -EA EMPLOYEE
$100,OOD
If yes. Please Eescri4a urMer SPECIAL PROVISIONS bebw
E.L DISEASE -POLICY LIMIT
O
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSIVEMCLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
CERTIFICATE HOLDER
CANCELLATION
1508028
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Fort Collins
THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
300 LaPorte Avenue
MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
Fort Collins, CO 80521
LEFT. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Patricia Smith
ACORD 25(2001I08)
Underwriter ACORD CORPORATION 1988
CERTIFICATE HOLDER COPY
City of Fort Collins
300 LaPorte Avenue
Fort Collins, CO 80521
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A
statement on this certificate does not confer rights to the certificate holder in lieu of such
endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract
between the issuing insurer(s), authorized representative or producer, and the certificate
holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded
by the policies listed thereon.