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HomeMy WebLinkAbout286209 BOULDER COUNTY COLORADO - INSURANCE CERTIFICATE (5)A4 ORD® CERTIFICATE OF LIABILITY INSURANCE164. DATE 12/3o/2aD"Ym 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 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 endorsements . PRODUCER Arthur J. Gallagher Risk Management Services, Inc. CONTACT NAME: PHONE FAX 6399 S. Fiddler's Green Cir., #200 Greenwood Village CO 80111-4949 fNC No Pro- IAIC. Nol, L INSURERS AFFORDING COVERAGE NAIC # INSURER A: Insurance Company of State of PA 19429 INSURED BOULCOU-02 INSURER B : INSURER C : BOULDER COUNTY COLORADO ATTN: MS. PAM STONECIPHER 2025 14TH STREET, FIRST FLOOR, INSURER D: BOULDER CO 80306 NSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 1866019711 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 INSURANCEA13DIL INSD Sulam MD POLICY NUMBER POLICY EFF MMIDD POLICY EXP MM/D LIMBS A X COMMERCIAL GENERAL LIABILITY 37723018 /112015 1/1/2016 EACH OCCURRENCE $Included CLAIMS -MADE �X OCCUR PREMISES Ea o=ueonce $Included X MED EXP(Any one person) $None $250.000 SIR PERSONAL B ADV INJURY $Included GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $10,000,000 X POLICY PRO- ROT ❑ LOC PRODUCTS - COMP/OP AGO $10,000,000 $ OTHER: AUTOMOBILE LIABILITY UM Ea accdent WNuLE LIMIT $ BODILY INJURY (Per Person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS BODILY INJURY (Per eodden0 $ HIRED AUTOS NON -OWNED AUTOS pROp A Per accident UMBRELLA LUU3 OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS UAB CLAIMS -MADE DIED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LUIBUUTY YIN PER OTH- STATUTE ER ANY PROPRIETORIPARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ NIA E.L. DISEASE EA EMPLOYE $ (Mandatary in NH) If yas desuibe ender DESCRIPTION OF OPERATIONS bebw E.L.DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, AddlBonal Remarks schedule, may be aftached if npre spa" b reQuln:d) CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED AS THEIR INTEREST MAY APPEAR TO THE GENERAL LIABILITY POLICY. CITY OF FORT COLLINS ATTN: PURCHASING DIVISION PO BOX 580 FORT COLLINS CO 80522 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. wurHors¢ED Revlu[sENrATrvE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD 008961