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HomeMy WebLinkAboutALM2S - INSURANCE CERTIFICATEALLER-3 OP ID: DA CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDYYYY) 04/03/2015 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 certificate holder in lieu of such endorsement(s). PRODUCER Brown & Brown Inc 4532 Boardwalk Dr, Suite 200 Fort Collins, CO 80525 Karen E. Siwek, CPA Diana Vigil .„. 970-482-7747 ttAtAXc_ lu,,v 970-484-4165 Pinnacol INSURED alm2s INSURERS: 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. INSR TYPE OF INSURANCE LTR U POLICY NUMBER POLICY EFF MMIDDIYYYY Y E POLICXP MM/DD LIMITS B X COMMERCIAL GENERALLuduLRY EACH OCCURRENCE S 1,000,00 CLAIMS -MADE O OCCUR X BOP3719966 04/09/2015 04/09/2016 _D�'MAGE TO RENTED PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) S 5,00 X EBL/EPL PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY ❑ JEST LOC PRODUCTS - COMP/OP AGG S 2,000,00 Em Ben. $ 1,000,00 OTHER: AUTOMOBILE LUUNLrrY COMBINED SINGLE LIMIT Ee accident $ 1,000,00 X BODILY INJURY (Per person) $ B ANY AUTO BOP3719966 04109/2015 04/09/2016 ALL OWNED SCHEDULED AOSAUTOS BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PP PERT DAMAGE $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,00 AGGREGATE s 2,000,00 B EXCESS LIAR CLAIMS -MADE SOP3719966 04/09/2015 04109=16 DIED I X I RETENTION $ 0 _ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTNE YIN OFFICERIMEMBER EXCLUDED? ❑ (Mandatory In NH) N/A 1961272 04/01/2015 04/01/2016 X PER OTH- T TLITE ER E.L. EACH ACCIDENT S 1,000,0 S 1,000,00( E.L. DISEASE - EA EMPLOYE It yes, describe under DESCRIPTION OF OPERATIONS below I S 1,000,00( EL. DISEASE - POLICY LIMIT C Professional DPL10004431601 12M4/2014 04/01/2016 Ea Claim 2,000,00 Liability Aggregate 2,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached R more space Is required) The City of Fort Collins is named additional insured with regards to general liability. CITYFT5 City of Fort Collins Purchasing Division PO Box 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD