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HomeMy WebLinkAbout130469 THE BRENDLE GROUP INC - INSURANCE CERTIFICATE (3)Client#: 1088762 BRENDGRO ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE12/08/2014B/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 Denver, CO 80202 CONTACT NAME: PNONE g00 673.8500 FAx ac No Eat :INC, No): ADDRESS: INSURER(3) AFFORDING COVERAGE NAICd INSURER A: Navigators Insurance Company 42307 INSURED The Brendle Group, Inc 212 West Mulberry Street Fort Collins, CO 80521 INSURER B : INSURER C INSURERD: 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 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. LTRR TYPE OF INSURANCE INRRL WO POLICY NUMBER MMJOD Y SEE MMIDD/YYYYPY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES (ESE�nOence) $ CLAIMS -MADE OCCUR MED UP (My we person) $ PERSONAL S ADV INJURY $ GENERALAGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acadenl $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per aoddenl) $ PROPERTY DAMAGE Per accident $ NONuOWNED HIRED AUTOS AUTOS 8 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEO RETENTION$ 1$ 1 WORKERS COMPENSATION OTH- WC STATU- IEE AND EMPLOYERS' LIABILITY Y I N OFFICERIMEMBER EXCLUDER/XECUTIVE❑ N/A E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) If yes, descrbe under DESCRIPTION OF OPERATIONS balm E.L. DISEASE -POLICY LIMIT $ A Professional Liab CM14DPLO3182 12/01/2014 12101/2015 $1,000,000 per claim Claims Made $2,000,000 annl aggr. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, AddiOonal Remarks Schedule. if more space Is required) City of Fort Collins Purchasing Attn:Ed 215 N. Mason Fort Collins, CO 80524-0000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. O" Vi 60, ACORD 25 (2010105) 1 of 1 #S13856951/M73856940 01988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD LXOBC staters n JL. STATE FARM FIRE AND CASUALTY COMPANY ' AAp STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS ,.DECLARATIONS AMENDED OCT 282014 S7oom land, lirO�ii NLgoot Policy Number 96-CW-8447-1 12 11 10 9 T-20-2359-FAF1 F U 001645 3123 Addl Insured -Section II Only CITY OF FORT COLLINS 215 N MASON ST 2ND FLOOR PO BOX 580 FORT COLLINS CO 80522-0580 Office Policy ! Policy Period Effective Date Expiration Date 12 Months DEC 3 2014 DEC 3 2015 The policy period be?ins and ends at 12:01 am standard time atthe premises 0catlon. Named Insured THE BRENDLE GROUP INC 212 W MULBERRY ST FORT COLLINS CO 80521-2814 Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subjectto the premiums, rules and forms in effector each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Entity: Individual Reason for Declarations: Your policy is amended OCT 28 2014 ADDITIONAL INSURED ADDED _ PREMIUM ADJUSTMENT FORM CMP-4786 ADDED Endorsement Premium Discounts Applied: Renewal Year Years in Business Enclosed Building Protective Devices Claim Record Prepared DEC 15 2014 CMP-4000 017529 290 Al N Other items shown are effective with the policy's 2014 renewal None © Copyright State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Continued on Reverse Side of Page Page 1 of 6 530 W 0 05 31-2911 Wn?3kI DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-CW-8447.1 SECTION I - PROPERTY SCHEDULE Location Location of Limit of Insurance` Limit of Insurance- Seasonal Number Described Increase - Premises Coverage A - Coverage B - Business Buildings Business Personal Personal Property Property 001 212 W MULBERRY No Coverage $ 216,800 25% FORT COLLINS CO 80521-2814 As of the effective date of this policy, the Limit of Insurance as shown includes any increase in the limit due to Inflation Coverage. SECTION I - INFLATION COVERAGE INDEXES) Cov A - Inflation Coverage Index: Cov B - Consumer Price Index: SECTION I - DEDUCTIBLES N/A 238.3 Basic Deductible $500 Special Deductibles: Money and Securities $$250 Employee Dishonesty $250 Equipment Breakdown $500 Other deductibles may apply - refer to policy. Prepared DEC 15 2014 © Copyright State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 017529 Continued on Next Page Page 2 of 6 StateFmm JL- DECLARATIONS (CONTINUED) , Office Policy for CITY OF FORT COLLINS Policy Number 96-CW-8447-1 SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EACH DESCRIBED PREMISES The coverages and corresponding limits shown below apply separately to each described premises shown in these Declarations, unless indicated by "See Schedule." If a coverage does not have a corresponding limit shown below, but has 'Included" indicated, please refer to that policy provision for an explanation of that coverage. COVERAGE Accounts Receivable On Premises Off Premises Arson Reward Back -Up Of Sewer Or Drain Collapse Damage To Non -Owned Buildings From Theft, Burglary Or Robbery Debris Removal Equipment Breakdown Fire Department Service Charge Fire Extinguisher Systems Recharge.Expense Forgery Or Alteration Glass Expenses Increased Cost Of Construction And Demolition Costs (applies only when buildings are insured on a replacement cost basis) Money And Securities (Off Premises) Money And Securities (On Premises) Money Orders And Counterfeit Money Newly Acquired Business Personal Property (applies only if this policy provides Coverage B - Business Personal Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides Coverage A - Buildings) Prepared DEC 15 2014 © Copyright State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 017530 290 Continued on Reverse Side of Page N LIMIT OF INSURANCE 50,000 15,000 $5,000 $15,000 Included Coverage B Limit 25% of covered loss Included $5,000 $5,000 $10,000 Included 10% $5,000 $10,000 $1,000 $100,000 $250,000 Page 3 of 6 a r e e 4 3 2 DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-CW-8447-1 Ordinance Or Law - Equipment Coverage Outdoor Property Personal Effects (applies only to those premises provided Coverage B - Business Personal Property) Personal Property Off Premises Pollutant Clean Up And Removal Preservation Of Property Property Of Others (applies only to those premises provided Coverage B - Business Personal Property) Signs Unauthorized Business Card Use Valuable Papers And Records On Premises Off Premises Water Damage, Other Liquids, Powder Or Molten Material Damage SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - PER POLICY Included $5,000 $5,000 $15,000 $10,000 30 Days $2,500 $2,500 $5,000 50,000 15,000 Included The coverages and corresponding limits shown below are the most we will pay regardless of the number of described premises shown in these Declarations. COVERAGE Dependent Property - Loss Of Income Employee Dishonesty Utility Interruption - Loss Of Income Loss Of Income And Extra Expense LIMIT OF INSURANCE $5,000 $10,000 $10,000 Actual Loss Sustained - 12 Months Prepared DEC 15 2014 © Copyright, State Farm Mutual Automobile Insurance Company, 200E CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 017530 Continued on Next Page Page 4 of 6 Statpefrm �a W- DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-CW-8447-1 SECTION II - LIABILITY COVERAGE Coverage L - Business Liability Coverage M - Medical Expenses (Any One Person) Damage To Premises Rented To You AGGREGATE LIMITS Products/Completed Operations Aggregate General Aggregate LIMIT OF INSURANCE $1,000,000 $5,000 $500,000 LIMIT OF INSURANCE Excluded $2,000,000 Each paid claim for Liability Coverage reduces the amount of insurance we provide during the applicable annual period. Please refer to Section II - Liability in the Coverage Form and any attached endorsements. Your policy consists of these Declarations, the BUSINESSOWNERS COVERAGE FORM shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequent to the issuance of this policy. FORMS AND ENDORSEMENTS CMP-4100 Businessowners Coverage Form CMP-4786 *Addl Insd Owners Lessee Schad CMP-4206.1 Amendatory Endorsement CMP-4845 Excl Product Comp Operatn Liab FE-6999.1 Terrorism Insurance Cov Notice CMP-4713 Excl Testing Consulting E&O CMP-4787 Waiver of Trans Rgt of Recov CMP-4819.1 Unauthorized Business Card Use CMP-4706 Back -Up of Sewer or Drain CMP-4704 Dependent Prop Loss of Income CMP-4710 Employee Dishonesty CMP-4709 Money and Securities CMP-4703 Utility Interruption Loss Incm Prepared DEC 15 2014 ® Copyright, State Farm Mutual Automobile Insurance Company, 2000 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 017531 290 Continued on Reverse Side of Page Page 5 of 6 N DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-CW-8447-1 CMP-4705 Loss of Income & Extra Expnse CMP-4746 Hired Auto Liability CMP-4785 Addl Ins Owners Lessee Blkt CMP-4788 Addl Insd Mgrs Lessor of Prom FD-6007 Inland Marine Attach Dec New Form Attached This policy is issued by the State Farm Fire and Casualty Company. Participating Policy You are entitled to participate in a distribution of the earnings of the company as determined by our Board of Directors in accordance with the Company's Articles of Incorporation, as amended. In Witness Whereof, the State Farm Fire and Casualty Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. Secretary President Prepared DEC 15 2014 CMP-4000 ® Copyright State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 017531 290 N Page 6 of 6 Staterarrn STATE FARM FIRE AND CASUALTY COMPANY 3 J6- A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS 81oom ni gtton, IL�61708a-0001 T-20-2359-FAF1 F U Named Insured THE BRENDLE GROUP INC 212 W MULBERRY ST FORT COLLINS CO-80521-2814 ATTACHING INLAND MARINE Policy Number 96-CW-8447-1 Policy Period Effective Date Expiration Date 12 Months DEC 3 2014 DEC 3 2015 The pollpy period beg9ins and ends at12:01 am standard time atthe premisesTocation. Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subjectto the premiums, rules and forms in effectfor each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lien holder written notice in compliance with the policy provisions or as required by law. Annual Policy Premium Included The above Premium Amount is included in the Policy Premium shown on the Declarations. Your policy consists of these Declarations, the INLAND MARINE CONDITIONS shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequentto the issuance of this policy. Forms, Options, and Endorsements FE-8739 Inland Marine Conditions FE-8743 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared DEC 15 2014 © Copyright State farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 017532 530 505 eY 0531 2011 I032320 96-CW-8447.1 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT NUMBER COVERAGE FE-8743 Inland Marine Computer Prop Loss of Income and Extra Expense Prepared DEC 15 2014 FD-6007 017532 LIMIT OF DEDUCTIBLE ANNUAL INSURANCE AMOUNT PREMIUM S 25,000 S 500 Included S 25,000 Included OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY © Copyright, State Form Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 0 530 655a.2 05-31.2011 I03233c1