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HomeMy WebLinkAbout273449 PONDER COMPANY INC - INSURANCE CERTIFICATE (2)78/28/2018 E � ACC)R" CERTIFICATE OF LIABILITY INSURANCE (MM/DD/YYYY) �� 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 have ADDITIONAL INSURED provisions or 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 NAME: Debbie Aranda Arthur J. Gallagher & Co. PHONE FAX Six Desta Dr., Ste. 5900 A/c No t : 806-748-2015 (A/C, No): 866-446-7371 EMAIL Midland TX 79705 ADDRESS: debbie_aranda_�aj .cg om INSURER A: Hanover Insurance Company 22292 INSURED PONDC.OM-01 INSURER a: Texas Mutual Insurance Company 22945 Ponder Company, Inc. INSURERc: Hanseatic Insurance Company Bermuda Limited 1545 W. Tufts Ave. Suite B - �- -- Englewood CO 80110 INSURER D : Argonaut Insurance Company 19801 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER. 175SCISS535 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. CY EXP INSR TYPE OF INSURANCE A OL BR POLICY NUMBER MM/DD YYYY MMPOLICY EFF LI D/YYY LIMITS TR A X COMMERCIAL GENERAL LIABILITY Y Y ZHDD02618802 8/31/2018 8/31/2019 EACH OCCURRENCE $1,000,000 PREMISES Ea occurrence $100,000 CLAIMS -MADE I X OCCUR MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY " jE O LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY Y Y AWDD02619502 8/31/2018 8/31/2019 COMBINED SINGLE LIMIT Ea accident $1000000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY r $ C X UMBRELLA LIAB X OCCUR Y Y UHDD02619102 8/312018 81312019 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 EXCESS LIAB CLAIMS -MADE DED I X I RETENTION $ B D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE Y TSF0002002365 928418620214 8/312018 8/312018 8/31/2019 8/312019 X STATUTE ERH E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED7 � NIA (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) ADDITIONAL INSURED: Certificate Holder is an Additional Insured as respects to the General Liability & Automobile policy, pursuant to the policy's terms, definitions, conditions and exclusions. Certificate Holder is included as Additional Insured on the General Liability & Automobile policy, as per endorsement #421-0452, edition (12-14) CG2037, edition (04-13) CG2010, edition (04-13) & 461-0478, edition (12-12). WAIVER OF SUBROGATION: Waiver of Subrogation applies to certificate holder, as respects to the General Liability & Automobile policy, pursuant to the policy's terms, definitions, conditions and exclusions. Waiver of Subrogation applies to certificate holder, as respects to the General Liability & Automobile policy, as per endorsement #CG2404, See Attached... CFRTIFICATF H01 17FR CANCELLATION 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 AUTHORIZEDRE�ENTATIVE Fort Collins, CO CO 80522 USA / (cJ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: PONDCOM-01 LOC #: ACORO) AnnITIMIAI RF:MARIIq grwrr1111 G AGENCY Arthur J. Gallagher & Co. POLICY NUMBER CARRIER NAIC CODE NAMED INSURED Ponder Company, Inc. 1545 W. Tufts Ave. Suite B Englewood CO 80110 EFFECTIVE DATE: PAnA i of 1 AUUI I IUNAL KhMAHKJ THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE edition (05-09), 461-0500, edition (11-13) and Workers' Compensation policy, as per endorsement#420304B, edition (06-14). PRIMARY AND NON-CONTRIBUTING: The insurance provided in the General Liability policy is primary and any other insurance shall be excess only, and not contributing. NOTICE OF CANCELLATION: The Workers' Compensation, General Liability and Business Automobile policies include an endorsement providing that 30 days notice of cancellation or coverage change will be furnished to the certificate holder. Re: Northside Aztlan Community Center - Rabbit Room Aerobics Floor The general liability and auto policies include blanket additional insured endorsements (attached) that provide additional insured status to the certificate holder only when there is a written contract between the Named Insured and the certificate holder that requires such status. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD