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HomeMy WebLinkAbout273449 PONDER COMPANY INC - INSURANCE CERTIFICATE (3)ACC)R" CERTIFICATE OF LIABILITY INSURANCE DATEE�(MM/DD/Y8YYY) 29/20 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 CONTACT Arthur J. Gallagher & Co. PHONE Debbie Aranda Fax ev Six Desta Dr., Ste. 5900 No Ext : 806-748-2015 A/c No): 866-446-7371 Midland TX 79705 E-MAIL__: debbie aranda0aia.com INSURERS AFFORDINGCOVERAGE NAIC# INSURER A: Hanover Insurance Company 22292 INSURED PONDCOM-01 INSURER B: Texas Mutual Insurance Company 22945 Ponder Company, Inc, INSURER C : Ar onaut Insurance Company 19801 1545 W. Tufts Ave. Suite B — Englewood CO 80110 INSURER D : Hanover American Insurance Company 36064 INSURER E : COVERAGES CFRTIFIRATI= KII IMRGR• QCvlelntal A11111AQC0. 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 I TYPE OF INSURANCE A DL SUBR POLICY NUMBER MM/DD/YYYY MM/D /YYY --- -- — -- LIMITS A X COMMERCIAL GENERAL LIABILITY OCCURIAOE-TO Y Y ZHDD02618802 1/31/2018 8/31/2019 EACH OCCURRENCE $ 1.000,000 RENTED —DACLAIMS-MADE1XI PREMISES Ea occurrence $100,000 MED EXP (Any one person) $10,000 _ PERSONAL & ADV INJURY $1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- F1 GENERAL AGGREGATE $ 2,000,000 POLICY JECT 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) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTYDAMAGE Per accident $ D UMBRELLA LIAB OCCUR Y Y UHDD02619102 8/31/2018 8/31/2019 EACH OCCURRENCE $5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE DED X RETENTION $ o $ B C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED7 N / A Y TSF0002002365 928418620214 8/31/2018 8/31/2018 8/31/2019 8/31/2019 X STATUTE ER E.L. EACH ACCIDENT $1,000.000 E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS! LOCATIONS! 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... CERTIFICATE HOLDER CANCELLATION City of Fort Collins PO Box 580 Fort Collins, CO CO 80522 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ATIVE ©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 #: A Ezac o� ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Arthur J. Gallagher & Co. NAMED INSURED Ponder Company, Inc. 1545 W. Tufts Ave. Suite B Englewood CO 80110 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS 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