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HomeMy WebLinkAbout457580 J F SATO & ASSOCIATES INC - INSURANCE CERTIFICATE (8)Client#: 1084594 JF5 ACORD.IE CERTIFICATE OF LIABILITY INSURANCE D 01109(MM/DD/Y2015 1/09/5 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 CONTACT NAME: USI Colorado, LLC Prof Liab PHONE 800 873-8500 Arc'ix ac, No, EX1 : , No 1515 Wynkoop Street EDMAIL Suite 200 ADDRESS: GE INSURERalty NAICR Denver, CO 80202 ce CI InsuraFORDINGnce INSURER A: Hartford Casualty Insurance Co 29424 INSURED INSURER B: XL Specialty Insurance Company 37885 J. F. Sato &Associates, Inc. 5878 So. Rapp Street INSURER L Littleton, CO 80120 INsuRERo: 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. IN RR TYPE OF INSURANCE ADDLSUBF NSR WVD POLICY NUMBER MMIDDY� MMMDY EXP LIMITS A GENERAL LIABILITY X X 34SBWPP2160 1/3112015 01/31/201 EACH $1,000000 X COMMERCIAL GENERAL LIABILITY �OCCCURRENCE pf�d PR EANO(EaEONcTwE once) $300 000 CLAIMS -MADE ER OCCUR MED EXP (Any one person) $10,000 PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY X PECO- LOC $ A AUTOMOBILELMBILITY X X 34SBWPP2160 1/31/2015 01131/2016 COMBINED SINGLE LIMIT Ea accident 1,000,000 BODILY INJURY (Per person) $ AUTO ALL OWNED SCHEDULED AUTOS AUTOS NANY BODILY INJURY (Pera¢idenf $ NON -OWNED HIRED AUTX OS AUTOS PROPERTY DAMAGE)$ Per accident A )(UMBRELLALIAB v I OCCUR X X 34SBWPP2160 1/31/201501131/201 EACH OCCURRENCE $8000000 AGGREGATE $$ 000 000 EXCESS LIAB CLAIMS -MADE DED I X RETENTION$10000 $ WORKERS COMPENSATION - H- AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A IDENT$ 9POLICYI$ EA EMPEE $ (Mandatory in NH) If yes, desonbe under DESCRIPTION OF OPERATIONS below DISEASE LIMIT $ B Professional DPR9714819 7118/2014 07/18/201 $1,000,000 per claim Liability $2,000,000 annl aggr. Claims Made DESCRIPTION OF OPERATIONS I LOCATIONS r VEHICLES (AHzch ACORD 101, Additional Remarks Schedule, If more space Is 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 is included as Automatic Additional Insured's for your work, acts or omissions which includes completed operations under General Liability; Designated Insured under Automobile Liability; and Additional Insured under Umbrella / Excess Liability but only with respect to liability arising out of the Named Insureds work performed on behalf of the (See Attached Descriptions) City of Fort Collins, Purchasing PO Box 580 Fort Collins, CO 80522-0000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Via ACORD 25 (2010/05) 1 of 2 #S14144219IM14143902 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BKSBC DESCRIPTIONS (Continued from Page 1) 1 certificate holder and owner. This insurance policies will apply on a primary and non-contributory basis. A Blanket Waiver of Subrogation applies for General Liability, Automobile Liability, Umbrella Liability. The Umbrella / Liability policy provides excess coverage over the General Liability, Automobile Liability and Employers Liability Additional Insured: City of Fort Collins SAGITTA 25.3 (2010105) 2 Of 2 #S141"219/M14143902