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HomeMy WebLinkAboutGOODWILL INDUSTRIES OF DENVER - INSURANCE CERTIFICATEI ® ,4 CERTIFICATE OF` LIABILITY INSURANCE DATE IMMDD/YYYY) 09/03/2014 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(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 endorsements). PRODUCER MARSH USA INC. 122517TH STREET, SUITE 1300 DENVER, CO 80202-5534 Attn: DENVER.CERTREQUEST@MARSH.COM FAX: (212) 948-4381 CONTACT NAME: PHONE FAX INC. No EMAIL ADDRE : ' INSURERS AFFORDING COVERAGE NAIC# INSURER A: Philadelphia Indemnity Insurance Company 18058 402175-STNDGAWU-14-15 INSURED GOODWILL INDUSTRIES OF DENVER INSURER B : Plnnacol Assurance 41190 6850 NORTH FEDERAL BOULEVARD INSURER C INSURER D: DENVER, CO 80221 INSURER E : INSURER F : COVERAGES rFRTIFIr:ATF NIIMRFR- SEA-002492032-02 REVISION NUMBER:4 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 ADDL INSR UBR Ma POLICY NUMBER POLICY EFF MMIDD/YYYY MIDDYIYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE M OCCUR PHPK1225341 09101/2014 0910112015 EACH OCCURRENCE $ 1,000,000 DAMAGET RENT D PREMISESEa occunence $ 1000000 MED EXP (My one ) $ 20,W0 PERSONAL d ADV INJURY !I $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE X POLICY' LIMIT APPLIES PER: PROJFC LOC PROUD AGG $ 3,000,000 $ A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON-0WNED X HIRED AUTOS X AUTOS PHPKI225341 0910112014 09/0112015 COMBINED SINGLE LIMIT Ea accide00 1,000,000 BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per acmdent $ $ UMBRELLA LAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LABILITY ANY PROPRIETORIPARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED9 Fq (Mandatory In NH) If deacnc under DESCRIPTION OF OPERATIONS below NIA 4133992 09/01/2014 0910112015 X I WC STATU- OTH- ITOR EL EACH ACCIDENT $OO,000 $ El. DISEASE - EA EMPLOYE E 500,000 E.L. DISEASE -POLICY LIMIT E 500.000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Mach ACORD 101, Additional Rama*s Schadula, If more space Is required) RE: CONTRACT TERM: 9-1-14 THROUGH 8-31-15 CITY OF FORT COLLINS IS NAMED AS ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY POLICY WHERE REQUIRED BY WRITTEN CONTRACT FOR GOODWILL'S NEGLIGENCE ONLY. r`FRTIFIr.ATF NTN nFR CANCELLATION CITY OF FORT COLLINS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO BOX 580 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN FORT COLLINS, CO 80522 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Kathleen M. Parsloe .Jfrx/lax.by-iQcdzAe- ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD