HomeMy WebLinkAbout442066 MARTIN/ MARTIN - INSURANCE CERTIFICATEMARTBMA-01 ROSEM
144coRO" CERTIFICATE OF LIABILITY INSURANCE
41%�
DATE(MM/DD/YYYY)
1 6/3/2014
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(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 endomement(s).
PRODUCER License # OE67768
IDA Insurance Services -SD
4360 La Jolla Village Drive, Suite 900(AC.No
San Diego, CA 92122
CONTACT Ali Smith
NAME:
PHONE FAX
EXt : (619) 574-6220 Ac Np/: (619) 574-6288
ADDRESS: Ali.Smith@ioausa.com
INSURER($) AFFORDING COVERAGE
NAICN
NSURER A: Charter Oak Fire Insurance Company
25615
INSUREDLxw%-4INSURERS:
Travelers Property Casualty Company Of America
25674
INSURER C: Travelers Indemnity Company
25658
Martin/Martin, Inc.
INSURER D: Starr Surplus Lines Insurance Company
13604
12499 West Colfax Avenue
Denver, CO 80215
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
LTR
TYPE OF INSURANCE
ADDLSUum
POLICY NUMBER
POLICY EFF
MM/DD"YY)
POUCY EXP
IMMIDONY"I
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE T OCCUR
6802275L118
06/01/2014
06/01/2015
EACH OCCURRENCE
$ 1,000,00
PREMISES Ea occurrence
$ 1,000,00
X
MED EXP(Any one person)
$ 5,00
Contractual Liab.
X
Deductible$0
PERSONAL BADVINJURY
S 1,000,00
GENL
AGGREGATE LIMIT APPLIES PER:
POLICY N PRO-
JECT1:1 LOC
GENERAL AGGREGATE
$ 2,000,00
PRODUCTS-COMPIOP AGO
$ 2,000,00
$
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea amitlent
$ 1,000,00
X
BODILY INJURY (Per person)
s
B
ANY AUTO
BA78461_848
06/01/2014
06/01/2016
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Peraaitlent)
$
HIRED AUTOS NON -OWNED AUTS
O
PROPERTY DAMAGE
Per accitleM
$
X
Comp.: $500 X Coll.: $500
$
X
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE
$ 9,000,00
AGGREGATE
$ 9,000,00
C
EXCESS LIAR
CLAIMS -MADE
CUP3D032440
06/01/2014
06/01/2015
DED I X I RETENTION$ 10,0001
S
B
WORKERS COMPENSATION
ANDEMPLOYERT LIABILITY YIN
ANY PROPRIETOR/PARTNER1 XECUTIVE
OFFICERIMEMBER EXCLUDED? FNINIA
UB4276T647
06/01/2014
06/01/2015
X PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,00
EL DISEASE - EA EMPLOYEE
S 1,000,00
(ManGaUV, in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS belw
E.L. DISEASE - POLICY LIMIT I
$ 1.000,00
D
Prof Liab/Clms Made!
SLSLPR026207314
OB/01/2014
06/01/2015
Per Claim 2,000,00
D
Ded.: $SOk Per Clam
SLSLPR026207314
06/01/2014
06/01/2015
Aggregate 3,000,00
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached Hmom space is rarluImd)
Re: RFP 7494 Parking Structures Conditions Assessments
The City of Fort Collins, its officers and employees is/are Additional Insureds) with respect to General Liability as required by written contract
City of Fort Collins
215 N. Mason 2nd Floor
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 RE,P1R�E^S�ENTATIVE
--I-A
CORPORATION. All rights mnamad
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD