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HomeMy WebLinkAbout264656 OZ ARCHITECTURE INC - INSURANCE CERTIFICATECERTIFICATE OF LIABILITY INSURANCE Goa//9n °""Y' 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 PRODUCER Van Gilder Insurance Corp. 1515 Wynkoop, Suite 200 Denver CO 80202 INSURED /_ OZArchitecture, Inc. 2646s6 3003 Larimer St. Denver CO 80205 COVERAGES CERTIFICATE NUMBER: 92nR32 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 LTR TYPE OF INSURANCE POLICY NUMBER MID EFF POLICYEXP umrro C GENERAL LIABILITY Y Y 380625OL363 0/1/2013 0/1/2014 EACH OCCURRENCE $1,000,000 PREMISES $1,000,000 %( COMMERCIAL GENERAL LIABILITY MED EXP onePerson) $10,000 CLAIMS -MADE Ix I OCCUR PERSONAL S ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2000.000 $ POLICY PRO-LOC X JFCT C AUTOMOBILE LIABILITY Y Y IA533IL412 10/1/2013 0/1/2014 Es accidem 1000000 BODILY INJURY (Per person) S X ANY AUTO BODILY INJURY (Per aocidere) $ 'X ALL OWNED SCHEDULED AUTOS NON-0WNED HIRED AUTOS X AUTOS PROPERTY DAMAGE Par acoidem $ S C X UMBRELLA UAB X OCCUR Y Y CUP3391T130 10IM013 0/1/2014 EACH OCCURRENCE $4,000,000 AGGREGATE S4,OD0,D00 EXCE98 LJAB CLAIMS4AADE DED X RETENTION$10000 I S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE YIN OFFICERIMEMSER E%CLUDED? (Mandatory in NH) MIA y 34WEGNX4686 0/1/2013 1011M14 X vPC STATI- 071+ E.L. EACH ACCIDENT $1.000.000 E.L. DISEASE - EA EMPLOYE $1,000,000 E.L. DISEASE - POLICY LIMIT 61000000 II yea, deecdbe under DE SCRIPTION OF OPERATIONS below Professional Liability Claims Made E823104 0/1/2013 101112014 Per Claim $2,000,000 Annual Aggregate $5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (A MuCh ACORD 101, Additional Remarlre Schedule, If more apace 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 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, Umbrella Liability and Workers' Compensation. Limited Contractual Liability is included. The Umbrella Liability policy provides excess coverage over the General Liability, See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. Attn: John Stephen 215 North Mason Street Fort Collins CO 80522 AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: A ® ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Van Gilder Insurance Corp. OZ Architecture, Inc. -- - 3003 Larimer St. POLICY NUMBER Denver CO 80205 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 Automobile Liability and Employers Liability. Additional Insured: City of Fort Collins and Poudre River Public Library District, 201 Peterson Street, Fort Collins, Co 80524 ACORD 101 (2008101) U 2008 ACORD CORPUKAI IUN. All rights reservea. The ACORD name and logo are registered marks of ACORD