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HomeMy WebLinkAboutALM2S - INSURANCE CERTIFICATE (2),a►��Ro CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/10/2015 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 PRODUCER Brown & Brown Inc 4532 Boardwalk Dr, Suite 200 Fort Collins, CO 80525 Karen E. Siwek, CPA INSURED alm2s 712 Whalers Way, Ste. B-100 Fort Collins, CO 80525 COVERAGES CERTIFICATE NUMBER: NAME: y' Diana Vigil _ e'r hl F.n. 970-482-7747 _ Nnt. 970-4844165 I INSURER A:Pinnacol Assurance Comoanv 141190 1 INSURER D : 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 AD POLICY NUMBER POLICY EFF MWO POLICY EXP MM/DD LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE I OCCUR X SOP3719966 04109/2015 04/0912016 PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,00 X EBLIEPL PERSONAL & ADV INJURY $ 1,000,00 j GGEEN'LAGGREGATE LIMIT APPLIES PER. PRO- POLICY 17 CLOC JECT GENERAL AGGREGATE E 2,000,00 PRODUCTS AGG O ,00 E 20,0 Em Ban. E 1,000,0 Y� OTHER AUTOMOBILE LIABILITY COMBINEDSINGLE LIMIT (Ea accident) $ 1,000,00( BODILY INJURY (Per person) $ B X ANY AUTO SOP3719M 04109=15 94/99/2016 ALL OWNED AUTOS TOS SCHEDULED AU BODILY INJURY (Per accident) E NON -OWNED HIREDAUTOS AUTOS PROPERTY DAMAGE Per sort ant) $ E X UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 2,000,00 AGGREGATE $ 2,000,00 BCOED EXCESS LIAR CLAIMS -MADE BOP3719966 04/09/2015 0410912016 X , RETENTION$ 0 $ WORKERS COMPENSATION AND EMPLOYERS' LABILITY A ANY PROPRIETOR/PARTNERIEXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? (Nlandstory in NH) N I A 1961272 94/01/2015 04/01/2016 X PER OTW STATUTE ER E.L. EACH ACCIDENT $ 1,000,0 E.L. DISEASE - EA EMPLOYEE $ 1,000,0 If yes, describe under DESCRIPTION OF OPERATIONS below I E.L. DISEASE- POLICY LIMIT 1 $ 1,000,0 C Professional DPL10004431601 12114IM14 04/01/2016 Ea Claim 2,000,00 Liability !Aggregate 2,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be aNached N more space is required) The City of Fort Collins is named additional insured with regards to general liability. L:tK I It -ILA I t HVLLi UANUtLLA I IVN CITYFT5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. Purchasing Division PO Box 580 AUTHORIZED REPRESENTATIVE \ / Fort Collins, CO 80522S—� V Lai ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ALLER-3 PAGE 2 NOTEPAD INSUREDS NAME alm2s OP ID: DA Dab 03/10/2015 When required by written contract the following applies: Blanket Additional Insured BP 0451 Primary and Non -Contributory BP 1488 Blanket Waiver of Subrogation BP 0497 Additional Insured - State or Governmental Agency or Subdivision or Political Subdivision - Permits or Authorization Relating to Premises BP 0407 Blanket Additional Insured - Owners. Lessees or Contractors with Additional Insured Requirements for Parties in Construction Conttact - BP 0451 Automobile - Blanket Additional Insured CA 0778 Blanket Waiver of Subrogation CA 0444 Umbrella - Following Form Workers Compensation - Blanket Waiver of Subrogation 359-B