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HomeMy WebLinkAbout106415 TURNING POINT FOR YOUTH AND FAMILY DEVELOPM - INSURANCE CERTIFICATEACORD. CERTIFICATE OF LIABILITY INSURANCE DATE/D) ll�07�2014o1a 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. Suite 100 Loveland, CO 80538 CONTACT NAME: Karole Peters FAX uc°N.EAJ 910.679.7355 AIC,Nd;866.237.2178 LA ADDRESS: karole-peters@leavitt.com INSURER(S) AFFORDING COVERAGE NAICN INSURER A: Hanover Insurance Company 22292 INSURED Turning Point for Youth and Family Development 1644 S. College Fort Collins, CO 80525 INSURERS: Pinnacol Assurance 41190 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 14-15 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 MD POLICY NUMBER MMIDDIYYYY MM/DDfYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR Z64-A467318-0 11/01/2014 11/01/2015 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 20,00 PERSONAL SADVINJURY S 1,000,00 GENERAL AGGREGATE $ 3,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC JECT PRODUCTS - COMP/OP AGG $ 3,000,00 $ A AUTOMOBILE UABIUTY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X X NON-0WNED HIRED AUTOS AUTOS AW4A467335 0 11I0112014 11/01/2015 Ea accident $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ Per accident) ERT7T $ $ A X UMBRELLA UAB EXCESSLIAB X OCCUR CLAIMS -MADE UH4-A467319-0 11110112014 11101/2015 EACH OCCURRENCE $ 2,000,00 AGGREGATE $ 2,000,000 DEC X RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PRO/MEMeOER EXCLUDED? ECUTIVrII (Mandatory in NH) If ves, descrlee under DESCRIPTION OF OPERATIONS below N / A 404416 10101/2014 10101/2015 X ITORY LIMITS ER E.L. EACH ACCIDENT S 500, OO E.L. DISEASE -EA EMPLOYEE $ S00, OO E.L. DISEASE -POLICY LIMIT $ 500,00 A Professional Liability ZB4-A467318-0 11/01/2014 1110112015 $3,000,000 Aggregate $1,000,000 Occurrence DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach 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, employees and volunteers are named as additional insured as it relates to.the Awesome Toss 'Em Cornhole Festival held on September 6, 2014. Liquor Liability $1,000,0000 limit. CERTIFICATE HOLDER CANCELLATION City of Fort Collins Risk Management PO Box 580 Fort Collins, CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE .l Karole 1988.2010 ACORD CORPORATION. All riahfs reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ACORQ CERTIFICATE OF LIABILITY INSURANCE DATE11/07/20147/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Ewing -Leavitt Insurance Agency 4025 St. Cloud Dr. Suite 100 Loveland, CO 80539 CONTACT NAME: Karole Peters Pa"c°NgE.t:970.679.7355 aG,Ne;866.237.2178 ADDRESS: karole-peters@leavitt.com INSURER($) AFFORDING COVERAGE NAICN INSURER A: Hanover Insurance Company 22292 INSURED Turning Point for Youth and Family Development 1644 S. College Fort Collins, CO 80525 INSURERS: Pinnacol Assurance 41190 INSURER C INSURER D: INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: 14-1S 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 MD POLICY NUMBER MMIDDIYYYY MMIDD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1XIOCCUR ZB4-A467318-0 11/01/2014 1110112015 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 100,000 MED EXP(My one person) $ 20,00 PERSONAL If ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 3,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC JECT PRODUCTS - COMP/OP AGO $ 3,000,00 $ A AUTO MOBILELIABILITY X ANY AUTO ALL AUTOS OWNED AUTOSSCHED X HIRED AUTOS N AIUTOSWNED AW4A467335 0 11/01/2014 11/01/2015 Easccident $ 1,000,00 BODILY INJURY (Per person) $ BODILY BODILY INJURY (Per acadent) $ Per accident $ 8 A 1( UMBRELLA LIM EXCESS LIAB X OCCUR CLAIMS -MADE UH4-A467319-00 11101/2014 11/01/2015 EACH OCCURRENCE $ 2,000,00 AGGREGATE $ 2,000,000 DED I X I RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFICERIMEMBER EXCLUDED? ANY ECUTIVF� (Mandatory In NH) DESCRIPTION OF OPERATIONS below N / A 404416 10/01/2014 10/01/2015 X H TORY LIMITS ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE- EA EMPLOYEE $ 50If 0, OO E. L. DISEASE-POLICYLIMIT $ SOO,OQ A Professional Liability ZB4-A467318-0011/0112014 11/01/2015 $3,000,000 Aggregate $1,000,000 Occurrence DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) E: Old Town Zombie Crawl - October 2S, 2014. 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 eld on October 25, 2014. CERTIFICATE HOLDER CANCELLATION City of Fort Collins Risk Management PO Box 580 Forst 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 .l Karol © 1988-2010 ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD