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Home My WebLink About244325 TURNING POINT FOR YOUTH AND FAMILY DEVELOPM - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE I DATE(MMIDDNYYY) i.12/02/2013 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 CONTACT NAME; Karole Peters Ewing -Leavitt Insurance Agency aNOEa;970.679.735S AC,NR;866.237.2178 4025 St. Cloud Dr. AODREs6: karole-peters@leavitt.com Suite 100 INSURER(S) AFFORDING COVERAGE NAICP Loveland, CO 80S38 INSURER A: Philadelphia Insurance Group A18058 INSURED Turning Point for Youth and Family Development INSURERS: Pinnacol Assurance 41190 1644 S. College INSURERC: Fort Collins, CO SOS25 2*4 32-5 INSURER 0 - I INSURER E : 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. LTRi TYPE OF INSURANCE NOR WVD POLICY NUMBER MMID MMOO LmrTs GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMSlMDE FXI OCCUR A PHPK110638 12/01/2013 11/01/2014 EACH OCCURRENCE S 1,000,00 PREMISES Es ocWrtente $ 1,000,00 MEDEXP(Any weperson) S 20,00 PERSONAL B ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 3,000,00 GENL AGGREGATE LIMIT APPLIES PER: X POLICY ECT LOC PRODUCTS-COMP/OP AGG $ 3,000,00 $ A AUTOMOBILE LIABILITY X ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X AUTOS NON -OWNED AUTOS PHPK1106389 12101/2013 11/0112014 EA aaidant $ 1,000 00 BODILY INJURY(Perpeleon) S BODILY INJURY (Per accdeM) S (Per ea'IOMI A X UMBRELLA LUIB EXCESSLIAS X OCCUR CLAIMS -MADE PRUB44229 1210112013 11/01/2014 EACH OCCURRENCE 1 000,00 AGGREGATE 1,000,00( DED X RETENTK7N$ 10,00 rS B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIV YIN OFFICER/MEMBER EXCLUDED? (MandatorylnNH) If Yes, describe under DESCRIPTION OF OPERATIONS below MIA 404416 10A7'I/2013 10/01/2014 X TORV LIMITS ER E.L. EACH ACCIDENT S00,00 - S00,00 E.L. DISEASE -EA EMPLOYE E.L. DISEASE -POLICY LIMIT I S 500,00 A Professional Liability PHPK110638 12/01/2013 11/01/2014 $3,000,000 Aggregate $1,000,000 Occurrence DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101. AddlOonal Remarks Schedule, N mms space Is reeulred) E: Cornhole Festival -Awesome Toss Em. August 3, 2013. The City of Fort Collins, its officers,agents, employees and volunteers are named as additional insured as it relates to the Awesome Toss 'Em Cornhole Festival held on August 3, 2013. Liquor Liability $1,000,0000 limit. City of Fort Collins Risk Management PO Box 580 Fort Collins, CO 80522-0580 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 All riahts reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ACORD CERTIFICATE OF LIABILITY INSURANCE DATE12/02/2013) /D M 013 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. IMPUK IFANI: It the certlhCate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. It SUBROGATION 15 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 Ewing -Leavitt Insurance Agency 4025 St. Cloud Dr. Suite 100 Loveland, CO 8OS38 WSURED Turning Point for Youth and Family Development 1644 S. College Fort Collins, CO 80525 CONTACT NAME: Karole Peters PHONE Arc, Ne:866.237.2178 ADDREss, karole-peters0leavitt.com WSURERIS) AFFORDING COVERAGE NAN:S INSURERA: Philadelphia Insurance Group A18OSS INSURERS: Pinnacol Assurance INSURERC: 41190 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 13-14 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. LTR TYPE OF INSURANCE NISR yryd POLICY NUMBER MWDD YMIDD Lmne A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX] OCCUR PHPK110638 12/01/2013 11/01/2014 EACH OCCURRENCE $ 1,000,000 PREMISES Eeoccurrence $ 1,000,00 RED EXP (Any one perm) $ 20,000 PERSONAL A ADV INJURY $ 11000,0001 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO X POLICY ILOC PRODUCTS-COMP/OP AGG S 3,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS PHPK1106389 12/0112013 11/01/2014 Ee edaaent S 1,000,00 BODILY INJURY(Perperson) i IX BODILY INJURY (Per acddam) $ X Per accident S S A X UMBRELLA UAB EXCESS LIAR X OCCUR CLAIMS -MADE PHUB44229 12M1/2013 1110'1/20'14 EACH OCCURRENCE 4 1,000,00 AGGREGATE $ 1,000,0 DED X I RETENTION E 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY OFFICERIMEMBEREXCLUDED?EC� (Mandeory In NH) Nyes, describe under DESCRIPTION OF OPERATIONS below NIA 404416 10/01/2013 10101/2014 X TORV LIMRS ER E.L. EACH ACCIDENT S 500,00( E.L. DISEASE -EA EMPLOYE _ S 500,0 00( E.L. DISEASE- POLICY LIMIT $ $00, 00 A ro essional Liability PHPKII061111 12M112013 11/01/2014 $3,000,000 Aggregate $1,000,000 Occurrence DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarlu Schedule, if more apace Is nqulred) E: Old Town Zombie Crawl - October 19, 2013. The City of Fort Collins, its officers, agents, employees and volunteers are named as additional insured as it relates to the Old Town Zombie Crawl which will be held on October 19, 2013. CERTIFICATE HOLDER CANCELLATION City of Fort Collins Risk Management PO Box 580 Fort Collins, CO 80522-0580 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 .J CORPORATION_ All rights reserved- ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD