HomeMy WebLinkAboutTRAMWAY 1 2013 LLC - INSURANCE CERTIFICATECUSTS-2 OP ID: TV
, hft� R CERTIFICATE OF LIABILITY INSURANCE
°A TE 1D01
1111112014
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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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terns 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
Commercial Risk Solutions DBA
6600 E. Hampden Ave.
Denver, CO 80224
CONTACT
NAME:
Pahc°Na Ea:303-996-7801 Fac No: 303-757-7719
ADDRESS:
Jeffrey Berven
INSURERS AFFORDING COVERAGE
NAIC N
INSURER A: Westfield Insurance
24112
INSURED Tramway 12013, LLC
INSURERS: P1nnacol Assurance
2840 Wilderness Place, Ste F
Boulder, CO 80301
INSURER C
INSURER D :
INSURER 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 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
LTR
TYPE OF INSURANCE
ADDL
SUER
POLICY NUMBER
MMI DD1`YYYY
MM/D rD/YYYY
LIMITS
A7
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
S 1,000,00
CLAIMS -MADE FX] OCCUR
X
CWP0126513
11/10/2014
1111012015
PREMISES Ea occurrence
S 600,00
MED EXP (Any one Person)
$ 6,00
PERSONAL It ADV INJURY
$ 1,000,00
GENT AGGREGATE LIMIT APPLIES PER.
GENERALAGGREGATE
S 2,000,00
POLICY JEo LOC
PRODUCTS-COMP/OPAGG
$ 2,000,00
$
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Eaa od.re
$ 1,000,00
X
BODILY INJURY (Per Person)
S
A
ANY AUTO
X
CWPO126513
11/1012014
1111012015
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per amkJerr)
$
X
PROPERTY DAMAGE
Peraccdad
$
X NON -OWNED
HIREDAUTOS AUTOS
S
X
UMBRELLA LIAR
X
OCCUR
EACH OCCURRENCE
$ 1,000,00
AGGREGATE
$ 1,000,00
A
E%OESS LIAR
CLAIMS -MADE
CWPO126513 1
1111012014
11110/2015
DE, X RETENTION$ 0
$
B
WORKERS COMPENSATION
ANDEMPLOYERS'LWBILITY
ANY PROPRIETORRARTNER/EXECUTIVE Y/N
OFFICER/MEMBER EXCLUDED? FT
(Mandatory In NH)
NIA
4160305
12/01/2014
12101/2015
X PER OTHER -
STATUTE
E.L. EACH ACCIDENT
$ 1,000,00
E. L. DISEASE EA EMPLOYEE
$ 1,000,00
rc yea. tlewibe under
DESCRIPTION OF OPERATIONS W.
E.L. DISEASE- POLICY LIMIT
$ 1,000,00
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Ramerlm Sehadula, may be attached I1 Mora apace Is rapulrec )
City of Fort Collins, its officers, agents and employees are included as
additional insured for ongoing operations on the General Liability and
included as additional insured on the Auto Liability with respect to
operations of the named insured for the certificate holder as required by
written contract. All policy terms, conditions and exclusions apply.
CITYOFF
City of Fort Collins
Purchasing & Risk Management
PO Box 580
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
9
9)1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD