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HomeMy WebLinkAboutCORRESPONDENCE - RFP - 7561 INSURANCE (3)CERTIFICATE HOLDER © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) AUTHORIZED REPRESENTATIVE CANCELLATION CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) JECT LOC PRO- POLICY GEN'L AGGREGATE LIMIT APPLIES PER: CLAIMS-MADE OCCUR COMMERCIAL GENERAL LIABILITY GENERAL LIABILITY PREMISES (Ea occurrence) $ DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ DED RETENTION $ CLAIMS-MADE OCCUR $ AGGREGATE $ UMBRELLA LIAB EACH OCCURRENCE $ EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNED AUTOS AUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) 00 CA0115 00 04 10 Page 1 of 1 This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR TRUCK CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM Under ✁ ✂ ✄ ☎ ✆ ✝ ☎ ☎ ✞ ✟ ☎ ✠ ✡ ☎ ✟ ☎ ✄ ☛ ✂ ✆ ☞ ✁ ✌ ✠ ✍ ✁ , the ✎ ✏ ✑ ✒ ✓ ✠ ✔ ☎ ✔ ✓ ✕ ✖ ✗ ✘ provision in paragraph ✠ ✙ ✚ is amended to include as an additional "insured" the person or organization who is required under a written contract with you to be included as an "insured" under this policy, but only with respect to their legal liability for acts or omissions of a person for whom Liability Coverage is afforded under this policy. All other terms and conditions of this policy remain unchanged. Endorsement Number: Policy Number: 41CAB4939006 Named Insured: ARTHUR J GALLAGHER & COMPANY This endorsement is effective on the inception date of this Policy unless otherwise stated herein: Endorsement Effective Date: 10/1/13 ✛ ✜ ✢ ✣ ✤ ✛ ✥ ✦ ✥ ✧ ✩ ✪ ✧ ★ ✫ ✪ ✩ ✫ ✩ ✬ 00 CA0115 00 04 10 Page 1 of 1 This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR TRUCK CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM Under ✁ ✂ ✄ ☎ ✆ ✝ ☎ ☎ ✞ ✟ ☎ ✠ ✡ ☎ ✟ ☎ ✄ ☛ ✂ ✆ ☞ ✁ ✌ ✠ ✍ ✁ , the ✎ ✏ ✑ ✒ ✓ ✠ ✔ ☎ ✔ ✓ ✕ ✖ ✗ ✘ provision in paragraph ✠ ✙ ✚ is amended to include as an additional "insured" the person or organization who is required under a written contract with you to be included as an "insured" under this policy, but only with respect to their legal liability for acts or omissions of a person for whom Liability Coverage is afforded under this policy. All other terms and conditions of this policy remain unchanged. Endorsement Number: Policy Number: 41CAB4938306 Named Insured: ARTHUR J GALLAGHER & COMPANY This endorsement is effective on the inception date of this Policy unless otherwise stated herein: Endorsement Effective Date: 10/1/13 ✛ ✜ ✢ ✣ ✤ ✛ ✥ ✦ ✧ ✦ ✪ ★ ✫ ✩ ✬ ✫ ✪ ✬ ✪ ✭ 00 GL0596 00 04 10 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM LIQOUR LIABILITY FORM PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE FORM SECTION II – WHO IS AN INSURED is amended to include as an additional insured the person or organization who is required under a written contract with you to be included as an insured under this policy, but only with respect to liability arising out of your operations or premises owned by or rented to you. All other terms and conditions of this policy remain unchanged. Endorsement Number: Policy Number: 41GPP4938406 Named Insured: ARTHUR J GALLAGHER & COMPANY This endorsement is effective on the inception date of this Policy unless otherwise stated herein: Endorsement Effective Date: 10/1/13 ✁ ✂ ✄ ✄ ☎ ✆ ✝ ✁ ✞ ✞ ✟ ✠ ✞ ✁ ✠ ✁ BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ 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 ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) 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). The ACORD name and logo are registered marks of ACORD COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: INSURED PHONE (A/C, No, Ext): PRODUCER ADDRESS: E-MAIL FAX (A/C, No): CONTACT NAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Chicago, IL 60606 1,000,000 6399 S Fiddler's Green Circle 1-312-704-0100 X Arthur J. Gallagher Risk Management Services, Inc. 1,000,000 N 10/01/15 City of Fort Collins, CO to $10 MIL policy agg. Gen Agg per loc subj. 41WCI4938107 (WI) 41WCI4938107 (AOS) X Suite 1900 300 South Riverside Plaza X X X X pushpachi X 10/05/2014 X Chi_Certificates@AJG.com A A ARCH INS CO (A XV) X 100,000 A 1,000,000 10/01/15 1,000,000 10/01/15 3,000,000 10/01/14 10/01/15 10,000 10/01/15 41763973 41763973 10/01/14 and the Auto Liability policy per form 00 CA0115 00 04 10 as required by written contract. 10/01/14 City of Fort Collins, CO is shown as an Additional Insured on the General Liability policy per form 00 GL0596 00 04 10 3,000,000 11150 A A 10/01/14 10/01/14 41CAB4938307 (AOS) 41CAB4939007 (MA) Fort Collins, CO 80522 Attn: Purchasing Department 1,000,000 Greenwood Village, CA 80111 USA Arthur J. Gallagher & Co PO Box 580 Direct All Inquiries to Email 3,000,000 41GPP4938407