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HomeMy WebLinkAbout457580 J F SATO & ASSOCIATES INC - INSURANCE CERTIFICATE (6)CERTIFICATE OF LIABILITY INSURANCE I DATE ^MMIDDIYYYY) 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 J. F. Sato & Associates, Inc. 5878 S. Rapp Street Littleton CO 80120 +515 8a Kathy Star COVERAGES CERTIFICATE NUMBER: 1703881087 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. INSK LTR TYPE OF INSURANCE ADDLSUSR POLICY NUMBER POLICY EFF MRWDNYYY) POLICY EXP IMMIDONYYYI UMrr3 B GENERAL LIABILITY Y Y 34SSWN09598 2124/2012 /31/2014 EACH OCCURRENCE $1,000,D00 X COMMERCIAL GENERAL LIABILITY A MISER 7kE occurrence) $300,000 CLAIMS -MADE OCCUR MED EXP(My one person) $10,000 PERSONAL S ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG 32000,000 POLICY RO- LOC X PIFrT $ B AUTOMOBILE LIABILITY Y 34SBWNO9598 1212412112 113112014 Eaeaitlere $1000000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Par accident) s X PROPERTY DAMAGE (Per $ NON-OVINED HIRED AUTOS AUTOS S B X UMBRELLA LIAB X OCCUR V 34SBWN09598 12/24/2012 /312014 EACH OCCURRENCE $8,000,000 AGGREGATE $8,000,000 EXCESS W18 CLAIM -MADE DEO I X I RETENTION $ 10.000 Is WORKERS COMPENSATION WC STATU- OTH- JMITOt AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTWE OFFICER/MEMSER EXCLUDED? N/A E.L EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT 1 $ A Professional Liability DPR9707637 /18/2013 /18/2014 Per Claim $1.000,000 Claims Made Annual Aggregate $2.000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addalonal 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/Excess Liability and Workers Compensation. The Umbrella / Excess Liability policy provides excess coverage over the General Liability, Automobile See Attached.,. L,1ZK I IFn.A I C MULLICK LANUCLLA I IUM 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 [/ ACORD 25 (2010/05) fd 19RRJn10 AGORn The ACORD name and logo are registered marks of ACORD All rinhfs AGENCY CUSTOMER ID: LOC #: A�RO* ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Van Gilder Insurance Corp. NAMED INSURED J. F. Sato & Associates, Inc. 5878 S. Rapp Street Littleton CO 80120 POLICY NUMBER CARRIER NAIL CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE and Employers Liability. gal Insured: City of Fort Collins ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD