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HomeMy WebLinkAboutLIBERTY COMMON SCHOOL - INSURANCE CERTIFICATE (2)LIBER-8 OP ID: DA '`'Il R� CERTIFICATE OF LIABILITY INSURANCE DAT06/031/YYYY) O6/03/14 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 Phone:970482-7747 NANEONTACT Brown & Brown Inc Fax: 9704844165 4532 Boardwalk Dr, Suite 200 Fort Collins, CO 80525 Karen E. Siwek, CPA PHONE FAX ArC Na EMI, INC, No): E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAICp INSURERA: Twin City Fire Ins. Co. 29459 INSURED Liberty Common School INSURER B: Pinnacol Assurance Compan 41190 Tim Ricketts 1725 Sharp Point Dr. Fort Collins, CO 80525 INSURERC:Hartford Casualty Insurance Co 29424 INSURER D:Owners Insurance Company 32700 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 DL POLICY NUMBER MWDD/YYYY MM/DD EXP /YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE IS 1,000,00 A X COMMERCIAL GENERAL LIABILITY X 34UUNRA2958 07/01/14 07/01/15 DAMAGE RENTED PREMISES Ea occurrence $ 300,00 CLAIMS MADE FX I OCCUR MED EXP (Any one person) $ 10,00 PERSONAL B ADV INJURY $ 1,000,00 X Educators Legal Claims Made GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,00 POLICY PRO- LOC $ AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT Ea accident $ 1,000,00 BODILY INJURY (Per person) $ D X ANY AUTO 4900313200 11109113 11/09/14 BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS PROPERTY DAMAGE Per accident $ NON -OWNED HIREDAUTOS AUTOS - X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 10,000,00 AGGREGATE $ 10,000,00 C EXCESS LIAB CLAIMS -MADE 34RHURA2216 07101114 07/01/15 DED I X I RETENTION $ 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICERUAEMBOEREXCLNERIEECUTIVE YI❑N (Mandatory in NH) NIA 4046263 07101/14 07101/15 X WCSTATU- OTH- TOR T EL EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEE $ SOO,OO If yes. describe under DESCRIPTION OF OPERATIONS below E. L. DISEASE -POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: Liberty Common High School Torch Trek The City of Fort Collins, its officers, agents, employees S volunteers are included as an additional insured if required by written contract per HG 0001 0605 CITYFOR City of Fort Collins Risk Management P.O. 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 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) . The ACORD name and logo are registered marks of ACORD LIBER-8 OP ID: DA CERTIFICATE OF LIABILITY INSURANCE DATE06/03DIYYYV) 1 6/03/14 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 Phone: 970-482-7747 CONTACT Brown & Brown Inc Fax: 970-484.4165 4532 Boardwalk Dr, Suite 200INC,No, Fort Collins, CO 80625 Karen E. Siwek, CPA PHONE FAX Ea[: {AIC No: E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC N INSURER A: Twin City Fire Ins. Co. 29459 INSURED Liberty Common School INSURER B: Pinnacol Assurance Company 41190 Tim Ricketts Share Point Dr. Fort Fort Collins, CO 80525 INSURER C: Hartford Casualty Insurance Co 29424 INSURERD:Owners Insurance Company 32700 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 A D BR POLICY NUMBER POLICY EFF MM/DD/YYYV POLICY EXP MWDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,00 A X COMMERCIAL GENERAL LIABILITY 34UUNRA2958 07I01114 07I01I15 DAMA ERENT D PREMISESS(Ea occurrence $ 300,00 CLAIMS -MADE FxI OCCUR MED EXP (Any one person) S 10,00 PERSONAL BADVINJURY $ 1,000,00 X Educators Legal Claims Made GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00 POLICY PRO- LOC $ LIABILITY BINEDSINGLE LIMIT accident $ 1,000,00 ILY INJURY (Per person) S D ANYAUTO 49003132/10 11/09113 11109114 NOMOBILE ALL OWNED SCHEDULED AUTOS AUTOS ILY INJURY(Per acadent) rPer $ PERTY DAMAGE accident $ NON -OWNED HIREDAUTOS AUTOS E X UMBRELLA LIAB X OCCUR EACH OCCURRENCE E 10,000,00 AGGREGATE $ 10,000,00 C EXCESSLIAB CLAIMS -MADE 34RHURA2215 07101M4 07101/15 DED X RETENTIONS 10000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORNARTNERIEXECUTIVE Y� OFFICERIMEMSER EXCLUDED? (Mandatory In NH) N/A 4046263 07/01/14 07/01/15 X TOR, OTH- Y LIMIT- ER E.L. EACH ACCIDENT $ 500,000 EL DISEASE -FA EMPLOYEES 5D0,00 It Sea. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICv uMiT S 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ANach ACORD 101, Additional Remarks Schedule, If more space Is required) RE: Liberty -to -Liberty 5K Run/Walk - The City of Fort Collins, its officers, agents, employees & volunteers are included as an additional insured if required by written contract per HG0001 0605 CITYFOR City of Fort Collins Risk Management P.O. 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 ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD