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HomeMy WebLinkAbout374454 ARTHUR J GALLAGHER RISK MGMT SERVICES INC - INSURANCE CERTIFICATEYSlGMIl WJR S_ ACIORibCERTIFICATE OF LIABILITY INSURANCE D10/05ATEIDDtt/2o14 ) to/os4 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 1-312-704-0100 CONTACT Direct All Inquiries to Snail Arthur J. Gallagher Risk Management Services, Inc. NAME. -' -'- - PHONE (AIL, No, EXt): (MC (NC, No): - 300 South Riverside Plaza E-MAIL ADDRESS: Chl Certificate.@AJG.Cnal Suite 1900 - - - - -- -' Chicago, IL 60606 INSURERIS) AFFORDING COVERAGE - NAIC8 INSURER A: ARCH INS CO (A XV) 11150 INSURED _. _ - INSURER B: Arthur J. Gallagher fi Co -- - --- INSURERL: 6399 S Fiddler•a Green Circle INSURER D: Greenwood Village, CA 80111 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER- 41763973 RFVISION NHMRFR- 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 UERT-NDI LTR TYPE OF INSURANCE INSRIADDIL POLICY NUMBER MYIDDIYYYY MNIDDYEIP IYYYY LIMITS A GENERAL LIABILITY 41GPP4938407 10/01/14 10/01/15 EACH OCCURRENCE S 1,000,000 X G__OMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES occurrence) $ 100, 000 CLAIMS -MADE `X 1 OCCUR MED EXP (Any one person) - $ 10,000 X Gen Agg per loc subi. PERSONAL B ADV INJURY $ 1,000,000 X to $10 NIL policy ago._ GENERAL AGGREGATE $ 3,000,000 G_E_N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 3,000,000 POLICY PRO A LOC IFCT E A AUTOMOBILE LIABILITY 41CAB4939007 (NA) 10/Ol 14 10/01/15 COMBINED SINGLE LIMIT 3,000,000 A X 41CAB4938307 (ADS) 30/01/1 10/01/15 ( $ ANY AUTO 50DILY�I) NJURY(Per person) E ALL OWNED SCHEDULED AUTO jI BODILY INJURY (Per accident $ X X NON -OWNED PROPPERTYIDAMAGE $- MIREDAUTOS AUTOS ,(Per E UMBRELLA LIAR OCCUR OCCURRENCE $ EXCESS LL1B CIAIMS-MADE AEACH GGREGATE DIED I IRETENTION$ S A WORXERSOOMPENSATION 41WCI4938107 (ADS) 10 /O1/14 10/O1/15 WC STATU- OTH- XTORY LIMIT$I ER AND EMPLOYERS' LIABILITY YIN - A ANY PROPRIETOWPARTNEMXECUTNE 41WCI4938107 (WI) 10/01/14' 10/01/15 EL EACH ACCIDENT E 1,000,000 OFFICERAIEMBER EXCLUDED? NIA -- - - - (Myaen4atory In NH) E L DISEASE - EA EMPLOYEE $ 1,000,000 it desonte RIPTION OF OPEMTION$ aglow DESC E.L. DISEASE -POLICY LIMIT I $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schodule, d more spat. is mquimd) City of Fort Collins, CO 1s shown as an Additional Insured on the General Liability policy per form 00 GL0596 00 04 10 and the Auto Liability policy per form 00 CA0115 00 04 10 as required by written contract. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y of Fort Collins, CO THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. n: Purchasing Department BOX 580 AUTHORIZED REPRESENTATIVE t Collins, CO 00522 �'% � �,✓ USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Vushpachi 41763973 YSIUU38Wl THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR TRUCK CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM Under SECTION II — LIABILITY COVERAGE, the Who is An Insured provision in paragraph A. 1 is amended to include as an additional "insured" the person or organization who is required under a written contract with you to be included as an "insured" under this policy, but only with respect to their legal liability for acts or omissions of a person for whom Liability Coverage is afforded under this policy. All other terms and conditions of this policy remain unchanged. Endorsement Number: Policy Number: 41 CAB4939007 Named Insured: ARTHUR J GALLAGHER & COMPANY This endorsement is effective on the inception date of this Policy unless otherwise stated herein: Endorsement Effective Date: 10/01/14 00 CA0115 00 04 10 Page 1 of 1 ARCH INSURANCE COMPANY a