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HomeMy WebLinkAboutALM2S - INSURANCE CERTIFICATE (3)ALLER-3 OP ID: DA AL(JKL! CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `� 1 0311012015 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 3rown & Brown Inc 11532 Boardwalk Dr, Suite 200 =ort Collins, CO 80525 Caren E. Siwek, CPA Diana Vigil n.970-482-7747 970.484-4165 INSURERS AFFORDING COVERAGE NAIC S INSURER A:Pli nacol Assurance Company 41190 INSURED aim2s INSURER B: Westfield Insurance Company 24112 712 Whalers Way, Ste. B-100 INSURER C: Endurance American Specialty 41718 Fort Collins, CO 80525 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. DL POLICY EFF POLICY EXP TYPE OF INSURANCE IN LTR SUB POLICY NUMBER MMfDDlYYYY MM/DD/YYYY LIMITS IF X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X BOP3719966 04/09/2015 04/09/2016 EACH OCCURRENCE S 1,000,00 DAMAGE TO RENTED PREMISES Eaocw ence $ 100,00 MED EXP (Any one person) $ 5,00 X EBL/EPL PERSONAL & ADV INJURY S 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE E 2,000,00 PRO - POLICY ❑ JECT LOC PRODUCTS - COMP/OP AGG E 2,000,00 Emp Ben. a 1,000,00 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMB Ea accident)6 1,000,00 130DILY INJURY (Per person) S B ANY AUTO X SOP3719966 04/09/2015 04/09/2016 ALL OWNED SCHEDULED AUTOS AUTOS E JX BODILY INJURY (Par accident) HIRED AUTOS NON -OWNED AUTOS _ $ PROPERTY DAMAGE Per accident S X UMBRELLA LIAR X OCCUR EACH OCCURRENCE S 2,000,00 AGGREGATE B EXCESS LIAR CLAIMS -MADE SOP3719M 04/09/2015 W0912016 S 2,000,00 DED X RETENTION $ 0 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? El (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 1951272 04/01/2015 04/01/2016 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE- EA EMPLOYEE $ 1,000,00 E.L. DISEASE - POLICY LIMIT $ 1,000,00( C (Professional DPL10004431601 12/1412014 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 attached if more space is required) City of Fort Collins and Wattle and Daub Contractors are Additional Insured with respect to General Liability and Automobile Liability. Project: 7666 Bobcat Ridge Historic Buildings Rehabilitation UCK I lr'IVA 1 C r1ULUCK L AN4CLLA I IVN CITYFC2 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. PO BOX 580 Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD ALLER-3 PAGE 2 NOTEPAD INSURED'SNAME alm2s OP ID: DA Date 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