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HomeMy WebLinkAbout439705 BELFORD WATKINS GROUP LLC - INSURANCE CERTIFICATE (13)Client#: 1083601 BELFOWAT ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIOD)YYYY) 11/04/2014 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 USI Colorado, LLC Prof Liab 1515 Wynkoop Street Suite 200 CONTACT Nancy R NAME: y Roman PHONE g00 873$500 ° E": ac,N°: �p� ADDRESS: Nancy.Roman@usi.biz Denver, CO 80202 INSURER(S) AFFORDING COVERAGE NAIL # INSURER A: Sentinel Insurance Company Ltd. 11000 INSURED INSURER B: XL Specialty Insurance Company 37885 Belford Watkins Group, LLC PO Box 1306 INSURER C: Fort Collins, CO 80522 INSURER D: NSURER E: INSURER F: 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 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. INSR LTR rypE OF INSURANCE ADDLSUB INSR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDD LIMITS A GENERALLIABILITY Y Y 34SBAPM7802 7/08/2014 07108/2015 EACH $1 OOO 000 ��OCCURRENCE PREMISES EaEnance $1 000000 X COMMERCIAL GENERAL LIABILITY CLAIMSMADE FRIOCCUR MED EXP(Any one person) $10000 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO $2,000,000 POLICY X jEaR LOC S A AUTOMOBILE LIABILITY Y Y 34SBAPM7802 7/08/2014 07/08/2015 COMBINED SINGLE LIMIT Ea acddent 1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS AUTOS X NON-0WNED AUTOS IXHIRED BODILY INJURY (Par accident) E PROPERTY DAMAGE Per aixWent $ $ A jt UMBRELLA LIAB N OCCUR Y Y 34SBAPM7802 0710312014 07/08/2015 EACH OCCURRENCE $1 000000 AGGREGATE $1 OOO 000 EXCESS LIAB CI -AIMS -MADE OED I X RETENTION$10000 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNERIEXEOUTIVE OFFICERIMEMBER EXCLUDED? NIA E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) If yes, descnbe under DESCRIPTION OF OPERATIONS below E. L. DISEASE -POLICY LIMIT I $ B Professional DPS9714206 3/15/2014 03/15/201 $1,000,000 per claim Liability T $1,000,000 annl aggr. Claims Made DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Anach ACORD 101, Additional Remarks Schedule, If mom apes. la required) As required by written contract or written agreement, the following provisions apply subject to the policy terms, conditions, limitations and exclusions: The Certificate Holder and owner are included as Automatic Additional Insured's for ongoing and completed operations under General Liability; Designated Insured under Automobile Liability; and Additional Insureds under Umbrella / Excess Liability but only with respect to liability arising out of the Named Insured work performed on behalf of the certificate holder and owner. (See Attached Descriptions) City of Fort Collins 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. AUTHORIZED REPRESENTATIVE VA." ACORD 25 (2010105) 1 of 2 #S13670168IM13669900 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NARBC DESCRIPTIONS (Continued from Page 1) I The General Liability, Automobile Liability, Umbrella/Excess insurance applies on a primary and non contributory basis. A Blanket Waiver of Subrogation applies for General Liability, Automobile Liability and Umbrella/Excess Liability. The Umbrella / Excess Liability policy provides excess coverage over the General Liability and Automobile Liability. Additional Insured: City of Fort Collins 5AGITTA 25.3 (2070/U5) 2 Ot 2 #S13670168IM13669900