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Home My WebLink AboutSURROUNDINGS LLC - INSURANCE CERTIFICATE (2)OP ID: SL ,acoizo CERTIFICATE OF LIABILITY INSURANCE D03/20/201ATE YY) 03/20/2014 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(les) 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 PFS Insurance Group -JT 4848 Thompson Pkwy, Ste 200 Johnstown, CO 80534 Dave Janssen NTACT NAME: PHONE FAX oINC.No: DDRE ADoaess: c MERID •BURRO-2 INSURER(S) AFFORDING COVERAGE NAIDt INSURED Surroundings, LLC INSURER A: ACIUlty Insurance Co. 14184 Andy Mill 6121 E. Harmony Road Fort Collins, CO 80525 INSURER B: INSURERC: INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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 LYR TYPE OF INSURANCE POLICY NUMBER DCY E F mumorryYYYt P UMITB A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX7 OCCUR X39278 04/01/2014 04/01/2015 EACH OCCURRENCE s 1,000,00 PREMISES Eacccu ence $ 300,00 MED EXP (An oneperson) S 5,00 PERSONAL B ADV INJURY S 1,000,00 GENERAL AGGREGATE S 2,000,00 GErrL AGGREGATE LIMIT APPLIES PER: 17 POLICY PRO- LOC JFr.TAUTOMOBILE PRODUCTS -COMPIOP AGO S 2.000,00 $ A LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS X39278 04101/2014 04/01120'15 COMBINED SINGLE LIMIT i $ 1.000,0 X BODILY INJURY BODILY NJURY (Per person) S BODILY INJURY (Per acdcaM) S PROPERTY DAMAGE (PER ACCIDENT) $ X X $ a A X UMBRELLALIAB EXCESS LIAR X OCCUR CLAIMS-SMDE X39278 04/0112014 04/01/2015 EACH OCCURRENCE { 1.,000,00 AGGREGATE S 11000, 000 DEDUCTIBLE RETENTION $ O S X S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory In NH) II yyes dosailce under OESCRIPTION OF OPERATIONS halaw NIA WC STATV- OTH- E.L. EACH ACCIDENT _-- $ E.L. DISEASE - PA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT "—'- - S A A Property Section X39278 04101/2014I 04101/2015 Limib See Belovu Deductibl 50 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ABach ACORD 101. Additional Remarks Schedule. It more space Is required) If required by written agreement, the certificate holder is included as additional insured for ongoing operations under general liability. Business Personal Property $450,000 Limit. CERTIFICATE HOLDER CANCELLATION FORTCOL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins Kiana Carter AUTHORIZED REPRESENTATIVE PO Box 580 Fort Collins, CO 80522-0580 /G. „ fZ, _ ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD OP ID: SL acoRO CERTIFICATE OF LIABILITY INSURANCE D03/20ATE /2014Y) �i 03/20/2014 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(les) 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 endomement(s). PRODUCER IFS Insurance Group - JT t848 Thompson Pkwy, Ste 200 Johnstown, CO 80534 INSURED Surroundings, LLC Andy Mill 6121 E. Harmony Road Fort Collins, CO 80525 nnlrcnwnEc CERTIEIcaTE NUMBER: 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 TR TYPE OF INSURANCE ADDL BUSH POLICY NUMBER MMIDD/YYYY POLICY UNITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMSH DE Fx� OCCUR X39278 04/01/2014 04/0112015 EACH OCCURRENCE $ 1,000,00 PREMISES(Be odamarlro S 300,00 MED EXP (Any one person) $ 5,00 PERSONAL BADV INJURY E 1,000,0 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE POLICY LIMIT APPLIES PER PRO- LOC PRODUCTS-COMP/OP AGG $ 2,000,00 s AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 9278 04/01/2014 04/01/2015 COMBINED SINGLE LIMIT (EaA i 1,000,00( X ILY INJURY BODILY BODILY INJURY (Per person) S BODILY INJURY (Per ecadwd) B PROPERTY DAMAGE (PER ACCIDENT) S X X = S A X UMBRELLA LIAR EXCESS UAB X OCCUR CLAIMS -MADE 39275 04/01/2014 OM01/2015 I EACH OCCURRENCE s 1,000,00 AGGREGATE S 1,000,00 DEDUCTIBLE RETENTION $ O S X S WORN ERSCOMPENSATION AND EMPLOYERS' UA81LITY ANY PROPRIETOR/PARTNERIEXECUTNE YIN OFFICERIMEMBER EXCLUDED' (Mandatory In NH) N rib yea, desce under DESCRIPTION OF OPERATIONS below NIA WC STATrU OTH- TR ER E.L. EACH ACCIDENT s E.L. DISEASE - EA EMPLOYEE S E.L. DISEASE - POLICY LIMIT S A A Property Section I X39278 G4/01/2014 04101I2015 Limits See Belo Deductibl 50 DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (Attach ACORD 101, Addltlonal Remarlm schedule, If mom space Is mqulmd) If required by written agreement, the certificate holder is included as additional insured for ongoing operations under general liability. Business Personal Property $450,000 Limit. CERTIFICATE HOLDER CANCFI I ATION FORTCOL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of Fort Collins PO Box 580 Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD