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HomeMy WebLinkAbout102584 COLORADOAN - INSURANCE CERTIFICATE�1 ao A�Rl7 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 09/27/2016 I 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 Aon Risk Services Northeast, Inc. New York NY Office CONTACT NAME: (aC.NNo. Ext): (866) 283-7122 (ac No ): (800) 363-0105 E-MAIL ADDRESS: One Liberty Plaza 165 Broadway, Suite 3201 INSURER(S) AFFORDING COVERAGE NAIC # New York NY 10006 USA INSURED INSURERA: National Union Fire Ins Co of Pittsburgh 19445 The Coloradoan INSURER B: New Hampshire Insurance Company 23841 1300 Riverside Ave. Fort Collins Co 80522 USA INSURERC: Illinois National Insurance Co 23817 INSURERD: American Home Assurance Co. 19380 INSURERE: Travelers Property Cas Co of America 25674 INSURER F: COVERAGES CER T iFiCAY E NUMBER: 570073282048 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. Limits shown are as requested INSR TR TYPE OF INSURANCE NSD WVD POLICY NUMBER MM/DD/YYYY MM DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GL 4 1 1 1 1 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X❑ OCCUR DAMAGET RENTED PREMISES Ea occurrence $1,000,000 MED EXP (Any one person) $10 , 000 PERSONAL 8 ADV INJURY $1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $1,000,000 X POLICY ❑ PRO- ❑ LOC JECT PRODUCTS - COMPIOP AGG $1,000,000 OTHER: A AUTOMOBILE LIABILITY CA 974-46-24 10/01/2018 10/01/2019 COMBINED SINGLE LIMIT Ea accident $1,000,000 ADS BODILY INJURY ( Per person) A X ANYAUTO CA 974-46-22 10/01/2018 10/01/2019 BODILY INJURY (Per accident) OWNED SCHEDULED MA q AUTOS ONLY AUTOS CA 974-46-23 101011201810/01/2019 PROPERTY DAMAGE HIREDAUTOS NON -OWNED VA Per accident ONLY AUTOS ONLY E X UMBRELLA LIAB X OCCUR ZUP61M3559918NF 10/01/2018 10/01/2019 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 EXCESS LIAB CLAIMS -MADE DED X RETENTION$10,000 B WORKERS COMPENSATION AND wc031467896 10/01/2018 10/01/2019 X STATUTE OTH EMPLOYERS' LIABILITY YIN AOS E.L. EACH ACCIDENT $1,000,000 B ANY PROPRIETOR / PARTNER / EXECUTIVE NIA wc031467891 10/01/2018 10/01/2019 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) ME E.L. DISEASE -EA EMPLOYEE $1,000,000 If yes, describe under D DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Evidence of insurance. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. The City of Fort Collins AUTHORIZED REPRESENTATIVE 215 N Mason St. Fort Collins CO 80524 USA �XXon ���,rD/c �u.�erd c/1vG�f�'Jli J� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000073845 LOC #: '4 ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk Services Northeast, Inc. NAMED INSURED The Coloradoan POLICY NUMBER see Certificate Number: 570073282048 CARRIER see Certificate Number: 570073282048 NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YYY POLICY EXPIRATION DATE MM/DD/YYYY LIMITSLTR WORKERS COMPENSATION C N/A wc031467892 FL 10/01/2018 10/01/2019 D N/A wc031467893 CA 10/01/2018 10/01/2019 B N/A wC031467894 WY 10/01/2018 10/01/2019 B N/A wC031467895 MA ND WI 10/01/2018 10/01/2019 ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD