HomeMy WebLinkAbout212187 WEATHERSURE SYSTEMS INC - INSURANCE CERTIFICATE (10)WEATH-1 OP ID: MMZ
,acoFto CERTIFICATE OF LIABILITY INSURANCE
`-/
DATE(M�ONYYY)
07/03/2014
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 conditionsofthe 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
CRS/Surescape Ins. Services
6600 E. Hampden Ave.
Denver, CO 80224
Douglas J. Rothey
CONTACT Douglas J. Rothey
PHONE 303.996.7801 FAx
Mc No Eat : ac No
E-MAIL rbur ess crsdenver.com
aoDREss: 9
ry
INSURER(SJ AFFORDING COVERAGE
NAICIf
INSURERA: PInnacol Assurance
XU
INSURED WeatherSure Systems, Inc.
INSURERIE:CNA
3333 S Platte River Drive
Sheridan, CO 80110
INSURERC:Hanover Insurance Co.
INSURERD:Nat'I Union Fire Ins/Pitts PA
19445
INSURER E
NSURERF:
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.
INTR
R
TYPE OF INSURANCEW&L
POLICY NUMBER
MMIODYD/YYYY
MMILDO�
LIMITS
B
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,00
CLAIMS -MADE FXI OCCUR
X
PMT6013803211
07101/2014
07/0112015
PREMISES Ea ommmm
$ 100,00
MED EXP(Any one Parson)
$ 5,00
X
PD Ded: $10,000
PERSONAL$ ADV INJURY
$ 1,000,00
GENT
AGGREGATE LIMIT APPLIES PER:
GENERALAGGREGATE
$ 2,000,0011
POLICY N PRO-
2,000,00JT
$
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea muodent
$ 1,000,00
C
X
ANVAUTO
AW4877561805
07/0112014
0710112015
BODILY INJURY (For pereon)
$
ALL OS SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per amdem)
$
X NON-OMED
HIRED AUTOS AUTOS
X
PROPERTY DAMAGE
Per ameent
f
f
UMBRELLA LIAR
X
OCCUR
EACH OCCURRENCE
$ 5,000,00
D
X
EXCESS LIAR
CLAIMS -MADE
BE017646492
0710112014
07101/2015
AGGREGATE
$ 5,000,00
DED I X I RETENTION$ 0
3
A
WORKERS COMPENSATION
ANDEMPLOYERS'LIABIUTY
ANY PROPRIETORIPARTNERIUECUTNE YIN
RA OFFICEREMBER EXCLUDED? ❑
(Mandttoryln NH)
NIA
3471401
07/01/2014
07101/2015
X PER OTH.
STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,00
E.L DISEASE - EA EMPLOYE
S 1-,000,00
If yes. describe unoer
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
S 1,000,00
B
Leased/Rent Equip
PMT6013803211
0710112014
0710112015
Limit 150,00
Special FormIACV
Ded 1,00
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddNlonal Ramalka Sbhadule, may W aNaehad N more a". le rwluled)
RE: 6064 Civic Center E Old Town Parking Garage
The certificate holder is included as additional insured on the General
Liability with respect to ongoing operations of the named insured for the
certificate holder as required by written contract. All policy terms,
conditions and exclusions apply.
City of Fort Collins
Attn: James B. O'Neill II
PO Box 580
215 N. Mason St., 2nd Floor
Ft. Collins, CO 80522
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
V I VUB-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD