HomeMy WebLinkAbout501149 FORT COLLINS MUSEUM OF DISCOVERY - INSURANCE CERTIFICATEFCMUS-1 OP ID: DA
CERTIFICATE OF LIABILITY INSURANCE
DAT
11/13D/YYVV)
11/13114
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 Phone: 970-482-7747
Brown & Brown Inc
4532 Boardwalk Dr, Suite 200 Fax: 970-484-4165
Fort Collins, CO 80625
Karen E. Siwek, CPA
CONTACT
NAME:
NC NN_,,t), ac Ne
E-MAIL
ADDRESS:
INSURER S) AFFORDING COVERAGE
NAIC 0
INSURER A: Philadelphia Indemnity Ins Co
18Q$8
INSURED Fort Collins Museum of
Discovery
408 Mason Ct
INSURERS: Pinnacol Assurance Compan
—
48058
1190
INSURERC:
INSURER D:
Ft Collins, CO 80524
INSURER E :
INSURER F :
' Ml VlcaIVIY ryUm6CK:
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,
ILTR TYPE OF INSURANCE A POLICY NUMBER POLICY EFF POLICY EXP
MM/DD(YYYY MM/DD/YYVY OMITS
A
GENERAL
LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE [OCCUR
PHPK1255366
11/09/14
04129/15
EACH OCCURRENCE
E 1,000,00
X
DAMA ET ENT
PREMISES fEa occurrence
S 100,00
NEDEXP(Any on. person)
E 6,00
PERSONAL ItADVINJURY
E 1,000,00
X
-
SeB Other COV
GENERAL AGGREGATE
E 2,000,00
GEN'L AGGREGATE
POLICY
_
LIMIT APPLIES PER:
PRO- LOC
PRODUCTS - COMPIOP AGG
$ 2,000,00
Emp Ben.
E 11000,00
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS _ AUTOS
HIRED AUTOS X NON -OWNED
AUTOS
PHPK1256366 1
11/09/14
04/29/15
COMBINcD SINGLE LIMIT
'Es accident
1,000,00
BODILY INJURY (Per person)
E
BODILY INJURY (Per acaEanq
E
X
ROPERTYDAMAGE P
PeracciJent
$
A
B
X
UMBREL
EXCESSLALIAB
EXCESS LIAR
OCCUR
CLAIMS -MADE
NIA
12310302
PHUB460086
11/09/14
07101114
04/29/15
05/01/15
EACH OCCURRENCE
E 1,000,00
T
AGGREGA. E
E 1,000,00
OEO it RETENTIONS 10000
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY
OFRCER/MEMBEREXCLUDE�ECUrNE Y/❑N
(Mandatory
(MeandNH)
in n und
s,dese y If yes, under
DESCRIPTION OF OPERATIONS below
WC STATU- OTH-
it A
E
E.L. EACH ACCIDENT
S 500,00
FASE -
E.L. DiSEA EMPLOYEE
S 600,00
_
E.L. DISEASE -POLICY LIMIT
$ 500,00
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
Certificate Bolder is listed as Additional Insured
r COTIorArC s.l . nvn _
FTCOLLI
City of Ft. Collins
Risk Management Department
215 N. Mason
Fort 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.
AUTHORIZEDREPRESENTATIVE
/
1988-2010 ACORD CORPORATION_ AN •ie.Nre. .a,ee.,..,a
AI VF LI ZD tatUTU/IID) The ACORD name and logo are registered marks of ACORD