HomeMy WebLinkAbout174626 FORT COLLINS HABITAT FOR HUMANITY INC - INSURANCE CERTIFICATE (2)OP ID: GH
d►��Ro CERTIFICATE OF LIABILITY INSURANCE
DAT04/02D/YVVV)
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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 endorsements .
PRODUCER 970-945-9111
Neil-ox 15 Agency, Inc.
PO Box 1576INC.No
Glenwood Springs, CO 81602
Genevieve Haywood
CONTACT
_NAME970-945-2350 PHONE ,E� FAR
Alt No:
E-MAIL
ADDRESS:
CUSTOMER I •FORTC-1
INSURE S AFFORD= COVERAGE
NAIL$
INSURED Fort Collins Habitat for I �1'7
Humanity, Inc. 17ZV
4001 South Taft Hill Rd
Fort Collins, CO 80526
INSURER A: Pinnacol Assurance
INSURER B:
INSURER L
INSURER D :
INSURER E :
INSURER F
COVERAGES CERTIFICATE NUMBER: 1 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.
ILTR
TYPE OF INSURANCE
POLICY NUMBER
EFF
NM DY/YYYY
MMCCDIYYYY
LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE1:71 OCCUR
EACH OCCURRENCE
S
PREMISES Ea aacmnce
$
MED EXP (Any ons peson)
S
PERSONAL S ADV INJURY
y
GENERAL AGGREGATE
S
GEN'L AGGREGATE
POLICY
LIMIT APPLIES PER:
F7 PRO- LOC
PRODUCTS-COMP/OP AGO
S
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMIT
(Es accident)
$
BODILY INJURY(PW person)
6
BODILY INJURY low accident)
_
PROPERTY DAMAGE
(PW amid M)
$
$
S
UMBRELLA LUTA
EXCESS W18
OCCUR
CLAIMS -MADE
!OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
ON
$
$
A
WORKERS COMPENSATION
AND EMPLOYERSLIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
OFFICER/MEMBER EXCLUDED? �Y
(Mandatory in NH)
R yss. describe under
DESCRIPTION OF OPERATIONS below
NIA
4154945
04I01N4
04I01115
X WC STAT - X OTH-
E.L. EACH ACCIDENT
S 1r000,00
E.L. DISEASE - EA EMPLOYEE
S 1,000,00
E.L. DISEASE -POLICY LINUT
S 1,000,00
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ANach ACORD 101, Additional Remarks Schedule, If Mora space Is required)
CERTIFICATE HOLDER CANCFI I ATinfJ
CITYOFF
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Fort Collins
Maggie MCLarlcy
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 580
AUTHORIZED REPRESENTATIVE
Fort Collins, CO 80522
C 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD