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Home My WebLink About565922 AU WORKSHOP LLC - INSURANCE CERTIFICATEClipnf#- 1090168 AUWORLLC ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) r 12/20/2018 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: PHONE g00 873-8500 A/C No Ext : A/C No): USI Colorado, LLC Prof Liab P.O. Box 7050 Englewood, CO 80155 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC p INSURER A: SeMlnel Insurance Company Ltd. 11000 800 873-8500 INSURED INSURER B : Hartford Ins Co of the Midwnt 37478 [au]workshop, Ilc : XLspe hY ar INSURER C cla InsumnceCompy 37885 405 Linden St Fort Collins, CO 80524 INSURER D INSURER E INSURER F : rnvcoer-Gc C.ERTIFIrATF NUMRFR: 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 CONTRACTOR 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 INSR IWVD SUB POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 34SBWPP2901 11/01/2018 11/0112019 EACHOCCURRENCE $1,000,000 PREMISES Ea occurrence $1,000,000 CLAIMS -MADE OCCUR MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OPAGG $2,000,000 POLICY PRO- LOC OTHER: A AUTOMOBILE LIABILITY Y Y 34SBWPP2901 11/01/2018 11/01/201 MIND$ Eeaocid.niSINGLELIMIT 1,000,000 BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOSHIRED NON-OWND X AUTOS ONLY X AUTOS NLY PROPERTY DAMAGE Per accident)$ - A X UMBRELLA LIAB X OCCUR Y Y 34SBWPP2901 11/0112018 11/01/201 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 EXCESS LIAB CLAIMS -MADE DED X RETENTION $10 000 $ _ _ _ _ t 3/08/2018 03/08/201 X PER oTH- -- B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICERIMEMBER EXCLUDED? � (Mandatory in NH) N I A Y 34WECAA0595 E.L. EACH ACCIDENT $100000 E.L. DISEASE - EA EMPLOYEE $100,000 E.L. DISEASE - POLICY LIMIT 1 $500,000 If yes, describe under DESCRIPTION OF OPERATIONS below C Professional DPR9923651 4/12/2018 04/12/2019 $1,000,000 per claim Liability $2,000,000 annl aggr. Claims Made DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) As required by written contract or written agreement, the following provisions apply subject to the policy terms, conditions, limitations and exclusions: The Certificate Holder and owner are included as Automatic Additional Insured's for ongoing and completed operations under General Liability; Designated Insured under Automobile Liability; and Additional Insureds under Umbrella / Excess Liability but only with respect to liability arising out of the Named Insured work performed on behalf of the certificate holder and owner. (See Attached Descriptions) CERTIFICATE HOLDER VAr1JUr LL.AIlVl1 i.l of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 580 ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins, CO 80522-0580 AUTHORIZED REPRESENTATIVE V l ytltl-LUI 0 At,VKU t,VKrvKAI IVPr-AH ngnw It_aCt vuu. ACORD 25 (2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S24540305/M24024569 SUSZP