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HomeMy WebLinkAbout366358 JVA INC - INSURANCE CERTIFICATECliental: 1093121 1IV/ill I11114 ACORDTa CERTIFICATE OF LIABILITY INSURANCE OATE(MlovWDO/Yzol4 osa 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 USI Colorado, LLC Prof Liab 1515 Wynkoop Street Suite 200 Denver, CO 80202 NTA NAME: PHONE (A/C, Eat: C, No 800 873-8500 "" 303.831.5295 AI EMAIL IL ADDRESS: INSURER(S) AFFORDING COVERAGE NAICN INSURER A: Charter Oak Fire Insurance Comp 25615 INSURED 2 1319Inc. V Spruce Street INSURER B: TraVB Iers Indemnity Company 25658 INSURERC: Pinnacol Assurance Company 41190 INSURER D: XL Specialty Insurance Company 37885 Boulder, Boulder, CO 80302 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 CONTRACTOR 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. LTN TYPE OF INSURANCE ADDLSUBR NSR WVD POLICY NUMBER MMIDOY� XP MMIDIOIYCY EYYY LIMITS A GENERAL LIABILITY X X 6801421LS60 5101/201405/01/2015 EACH OCCURRENCE $1,000000 PREMISES Ea occurrence 81 OOO OOO X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 51OCCUR MED EXP(Any one person) $10000 PERSONAL S ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY X jR T LOC $ A AUTOMOBILE LIABILITY X X BA1696L578 5/01/2014 05101/201 COMBINEDSWGLE LIMIT 1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) E X PROPERTY DAMAGE Peracddent $ HIRED AUTOS X NON"NED AUTOS S B X UMBRELLA UAB X OCCUR X X CUP6968Y20A 5/01/2014 05/01/2015 EACH OCCURRENCE $1 000 000 AGGREGATE $1 o0O O00 EXCESS LIAB I CIAIMS-MADE DED X 1ETENTION$10000 I$ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N OFFICER/MEMBER EXCLUDED? N/A X 4131403 5/01/201405/01/2015X wcsTATu- OTH- E.L. EACH ACCIDENT $1 000 000 E.L. DISEASE - EA EMPLOYEE $1,000000 (Mandatory in NH) d yes, dascbw, under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1nnn ,DDO D Professional PR9710506 D510112014 05I01/201 $2,000,000 per claim Liability $3,000,000 annl aggr. Claims Made DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional 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 and owner are included as Automatic Additional Insured's for ongoing and 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. (See Attached Descriptions) City of Fort Collins Operation Services 300 LaPorte Ave., Building B Fort Collins, CO 80521-0000 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) 1 of 2 #S12411154/M12411106 ©1988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD LXOBC DESCRIPTIONS (Continued from Page 1) 1 The General Liability, Automobile Liability, Umbrella/Excess insurance applies 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 Liability and Employers Liability. City of Fort Collins SAGITTA 25.3 (2010/05) 2 Of 2 #S12411154IM12411106