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HomeMy WebLinkAboutALM2S - INSURANCE CERTIFICATE (4)ALLER-3 OP ID: DA .4COR0° �� CERTIFICATE OF LIABILITY INSURANCE ATE 4/025 FD04/02//2 Y015 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 Brown 8 Brown Inc 4532 Boardwalk Dr, Suite 200 Fort Collins, CO 80525 NAMEACT Diana Vigil PHONE 970-482-7747 FAX, A/C No Eat: No: 970-484-4165 A DRESS: dvigil@bbcolorado.com Karen E. Siwek, CPA INSURE S AFFORDING COVERAGE NAIL 0 INSURER A: Pinnacol Assurance Company 41190 INSURED alm2s INSURER 8: Westfield Insurance Company 24112 712 Whalers Way, Ste. B-100 Fort Collins, CO 80525 INSURER c: Endurance American Specialty 41718 INSURER D : INSURER E : INSURER F : rnvclaeccs rGRTIFICATF NI IMRFR- RFVISION NIIMRFR- 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 OF INSURANCE L ADOTYPE U POLICY NUMBER LICY EFF MM DDNYYYI POLICY EXP (MM/DDtYYYYI LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000, CLAIMS -MADE 1XI OCCUR X BOP3719966 04/09/2015 04/09/2016 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,0 X EBLIEPL PERSONAL & ADV INJURY $ 1,000,0 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000, POLICY ❑ PRO JECT ❑ LOC PRODUCTS -COMP/OP AGG $ 2,000,001 Emp Ben. $ 1,000,0 OTHER: AUTOMOBILE IJABILr Y O BINEDtSINGLE LIMIT am $ 1,000,00 BODILY INJURY (Per person) $ B X ANY AUTO X BOP3719966 04/09/2015 OM09/2016 ALL OWNED SCHEDULED Aurros AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON OWNED HIRED AUTOS AUTOS $ X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 2,000,00 AGGREGATE $ 2,000,00 B EXCESSLLAB CLAIMS -MADE BOP3719966 04/09/2015 04/09/2016 DED I X I RETENTION$ 0 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN A ANY PROPRIETOR/PARTNERJEXECUTNE 1951272 04/01/2015 04/01/2016 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) MIA E.L. DISEASE • EA EMPLOYEE $ 1,000,0 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT Is 1,000,0 C Professional DPL10004431601 12/14/2014 04101/2016 Ea Claim 2,000,00 Liability Aggregate 2,000,0011 DESCRIPTION OF OPERATIONS / 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 CERTIFICATE HOLDER CANCELLATION CITYFC2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins PO Box 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD No Text