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HomeMy WebLinkAbout343965 IN-SITU INC - INSURANCE CERTIFICATEClient8: 49195 INSIN2 ACORD. CERTIFICATE OF LIABILITY INSURANCE D TE 9/0212/00/YYYY) 1/02/2014 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 endorsement(s). PRODUCER Flood & Peterson Ins., Inc. P. O. Box 578 Greeley, CO 80632 970 356-0123 NAME, Sandy Schifferns FAX A/Co"r; Et): 970 266-7107 1 tAIC, No), 970 506-6845 E-MAIL sschifferns flood eterson.com ADDRESS: P INSURER(S) AFFORDING COVERAGE NAIL # INSURER A: Atlantic Specialty Insurance Co 27154 INSURED In -Situ, Inc. 221 E Lincoln Ave INSURER B : INSURER C Fort Collins, CO 80524 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 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. INSR LTR rypE OF INSURANCE ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD/YYYY LIMBS A GENERALLMBILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE � OCCUR 7110127690003 9/01/2014 09/0112015 EACH OCCURRENCE $1,000,000 PREMISES Eaoccu ante $500000 MED EXP (Any one person) $10,000 PERSONAL &ADV INJURY $1,000,000 GENERALAGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOG JECT PRODUCTS - COMPIOP AGO $2,000,000 $ A AUTOMOBILE LIABILITY X ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AS X NON -OWNED AUTOS X OC 7110127690003 9/01/2014 09/01/201 COMBINED SINGLE LIMIT Ea accident) 1,000,000 BODILY INJURY person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ A X UMBRELLA LIAB EXCESS UAB X OCCUR CLAIMS -MADE 7110127690003 9/01/2014 09101/2015 EACH OCCURRENCE s5,000.000 AGGREGATE $S 00O 000 DED I X I RETENTION$0 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/" ANY PROPRIETORIPARTNER/EXECUVE TI OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A 4060411270001 9/01/2014 09/01/201 X WCgs A^ T OT - RH E.L. EACH ACCIDENT $1000000 E.L. DISEASE - EA EMPLOYEE $1 000,000 E.L. DISEASE -POLICY LIMIT $1,000,000 A Other States WC Employers Liab 4060411270001 9/01/2014 09/01/2015 $1,000,000 per Accident perEmployee;PolicyLimit DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) City of Fort Collins 300 Laporte Ave Fort Collins, CO 80526 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) 1 of 1 The ACORD name and logo are registered marks of ACORD SS93n2R3/Mg2gR2't M7S