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HomeMy WebLinkAbout186415 TURNING CENTER FOR YOUTH & FAMILY - INSURANCE CERTIFICATE (2)ATE AC40R" ® CERTIFICATE OF LIABILITY INSURANCE D11�1/zo1e ) 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 endorsements . PRODUCER CONTACT Karole Peters Ewing -Leavitt Insurance Agency, Inc. 4090 Clydesdale Parkway Suite 101 Loveland CO 80538 NAME: PHON o.ExU: (970) 679-i3355 FAX No: (866)237-2178 E-MAILcc. karole-peters@leavitt.com Annpp NAIC # 22292 INSURED INSURER B :Pinnacol Assurance 41190 Turning Point Center for Youth and INSURERC: Family Development Inc. INSURERD: 1644 S. College INSURERE: Fort Collins CO 80525 INSURERF: rOVFRAr,FS CFRTIFIrATF NI IMRFP-18-19 Dt=\/ICIf1CU til ItURGD- 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F OCCUR Blkt Additioinal Insured X ZZ4-A467318-04 11/1/2018 11/1/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence) $ 100,000 X MED EXP (Any one person) $ 20,000 X Blkt Waiver of Subro PERSONAL & ADV INJURY $ 1,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICYEl PRO LOC JECT OTHER: GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP/OP AGG $ included $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS AW4A467335 04 11/1/2018 11/1/2019 COMBINED SINGLE LIMIT Ea ccident a $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE UH4-A467319-04 11/1/2018 11/l/2019 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DED I X I RETENTION 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER,'EXECUTIVE Y� OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 4044167 Blanket Waiver of Subrogation 10/1/2018 10/1/2019 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 A Professional Liability ZZ4-A467318-04 11/1/2018 11/1/2019 Aggregate $3,000,000 Occerrence $1, 0 0 0, 0 0 0 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Cornhole Festival -Awesome Toss Em. August 25, 2018.The City of Fort Collins, its officers,agents, employees and volunteers are named as additional insured as it relates to the Awesome Toss 'Em Cornhole Festival held on August 25, 2018. Liquor Liability $1,000,0000 limit. l,tK I IrIUA 1 t MULUtK UANUtLLA I IUN City of Fort Collins Risk Management PO Box 580 Fort Collins, CO 80522-0580 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 Karole Peters/KAPETE 09<-M�� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INSf19R nn1nnl�