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Home My WebLink About186415 TURNING POINT CENTER FOR YOUTH & FAMILY - INSURANCE CERTIFICATEACORD. CERTIFICATE OF LIABILITY INSURANCE DATE1/zola to/01/2014 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 Ewing -Leavitt Insurance Agency 402S St. Cloud Dr. Suite 100 Loveland, CO 80538 CONTACT NAME: Karole Peters acNa;866.237.2178 OE,t;, karle-peters@leavitt.com INSURER(S) AFFORDING COVERAGE NAICIf INSURER A: Philadelphia Insurance Group A18058 INSURED Turning Point for Youth and Family Development 1644 S. College Fort Collins, CO 80525 INSURERB: Plnnacol Assurance 41190 INSURER C: INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 14-15 WC Update 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. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYYY MMIDD/YYYV LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CIAIMS-MADE rX1OCCUR PHPKII06389 1210112013 11/0112014 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 1,000,000 NED EXP(Anyone person) $ 20,00 PERSONAL 8 ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 3,000,00( GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC ECT PRODUCTS - COMP/OP AGG $ 3,000,00 $ A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED$ X HIRED AUTOS N PHPK110638 12I01I2013 11/01I2014 Ea accident $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERAUTOS Per acddent AEXCESS X UMBRELLA DAB LIAB X OCCUR CLAIMS -MADE PHUB44229 12/01/2013 11/01/2014 EACH OCCURRENCE $ 2,000,00 AGGREGATE $ 2 , 000, 0O CEOX RETENTION $ 10, 00 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIV OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DE SCRIPTION OF OPERATIONS below NIA 4044167 1010112014 10/01/2015 X TORY LIMIT$ ER E.L. EACH ACCIDENT $ SOO,OO E.C. DISEASE - FA EMPLOYEE'$ 100,00 E.L. DISEASE -POLICY LIMIT $ 500,00 A Professional Liability PHPK110638 '12101/2013 11/01/2014 $3,000,000 Aggregate $1,000,000 Occurrence DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Atbch ACORD 101, Additional Remarks Schedule, If more space Is required) E: Cornhole Festival -Awesome Toss Em. September 6, 2014.The City of Fort Collins, its officers,agents, mployees and volunteers are named as additional insured as it relates to the Awesome Toss 'Em Cornhole estival held on September 6, 2014. Liquor Liability $1,000,0000 limit. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins Risk Management PO Box 580 Fort Collins, CO 80522-0580 K"-*& ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ACORD CERTIFICATE OF LIABILITY INSURANCE iM 10 INN//Ol/2014014) 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 Ewing -Leavitt Insurance Agency 4025 St. Cloud Dr. CONTACT NAME: Karole Peters Pa"co"r E:e:970.679.7355 aC,Np;866.237.2178 no less: karole-peters@leavitt.com Suite 100 INSURER(S) AFFORDING COVERAGE NAICN Loveland, CO 80538 INSURER A: Philadelphia Insurance Group A18058 INSURED Turning Point for Youth and Family Development INSURERB: Pinnacol Assurance 41190 1644 S. College INSURER C: Fort Collins, CO 80525 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 14-15 WC Update 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. NTR TYPE OF INSURANCE INSR WVD POLICYNUMBER MMIDDIYYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIM$ -MADE � OCCUR PHPK110638 '12/01/2013 11101/2014 EACH OCCURRENCE $ 1,000,00 ZENTED— PREMISES Ea occurrence $ 1,000,00 MED EXP(Any one person) $ 20,00 PERSONAL& ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X1 POLICY JECT PRO- LOC PRODUCTS - COMPIOP AGG $ 3,000,00 $ A AUTOMOBILE LIABILITY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X NON-0WNED AUTOS PHPK1106389 1210112013 11/0112014 Eaaccident) $ 1,000,00 X MANY BODILY INJURY (Per person) $ BODILY INJURY (PerettidenQ $ NHIREDAUTOS Per PERT nt $ A X UMBRELLALIAB EXCESS UAB X OCCUR CLAIMS -MADE PHUB44229 12/01/2013 11/01/2014 EACH OCCURRENCE $ 2,000,00 AGGREGATE $ 2,000,000 DED X RETENTION $ 10, 00C I $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNER/EXECUTIV OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 404416710/01/201410101/2015 XUlm TORY LIMITS ER E.L. EACH ACCIDENT $ SOO 0O E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500, OO A Professional Liability PHPK110638912101/2013 11/0112014 $3,000,000 Aggregate $1,000,000 Occurrence DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) E: Old Town Zombie Crawl - October 19, 2013. The City of Fort Collins, its officers, agents, employees and volunteers are named as additional insured as it relates to the Old Town Zombie Crawl which will be held on October 19, 2013. City of Fort Collins Risk Management PO 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 Karole Pete K ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD CORPORATION. All