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HomeMy WebLinkAboutCA PROPERTY OWNER FORT COLLINS LLC - INSURANCE CERTIFICATEACOR& CERTIFICATE OF LIABILITY INSURANCE klk_� 8/11/2019 DATE(MM/DD/YYYY) 2/l/2019 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 LOCKTON COMPANIES 500 West Monroe, Suite 3400 CHICAGO IL 60661 (312) 669-6900 NCONTACT ,Oki FAX A/c No Ext : Arc, No): E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Admiral Insurance Com anV 24856 INSURED CA Property Owner Fort Collins, LLC 1446337 130 East Randolph Street, Ste 2100 Chicago IL 60601 INSURER B : Navigators Specialty Insurance Company 36056 INSURER C : The Travelers Indemnity Company 25658 INSURER D : INSURER E : Berkshire Hathaway Homestate Ins Co 20044 INSURER F :— _ COVERAGES CERTIFICATE NUMBER: 15369473 REVISION NUMBER: XXXXXXX 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 INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR No Deductible/SIR Y N CA000010581-13 1/31/2019 1/31/2020 EACH OCCURRENCE 1,000000 PREMISES (ETO a olccurrrence) $ 300,000 X MED EXP (Any oneperson) 5,000 PERSONAL & ADV INJURY $ 1,000 OOO GEN'L AGGREGATE LIMIT APPLIES PER. POLICY___] JECOT � LOC OTHER: GENERAL AGGREGATE $ 2,000 000 PRODUCTS - COMP/OP AGG $ 1,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY AUTOSULED AUTOS ONLY X AUTOS ONLY N N CA000010581-13 1/31/2019 1/31/2020 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ XXXXXXX BODILY INJURY (Per accident $ Xj(j(}{XXX X PerOaccltlenDAMAGE $ XXXXXXX $XXXXXXX B ){ UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE N N CHI9EXC8632041C 1/31/2019 1/31/2020 EACH OCCURRENCE $ 10000000 AGGREGATE $ 10,000,000 DED I I RETENTION $ $ XXXXXXX E WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes. describe under DESCRiPTiON Gr OPERATIONS below N / A N CAWCO29899 2/1 /2019 2/l /2020 I PER X STATUTE OER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE 1,000.000 E.L. DISEASE - POLICY LIMIT (� (� 1 0 V V 00 V C Property: N N KTJ-CMB-31-174443-7-18 8/11/2018 8/11/2019 Building: $24,170,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Uncommon Fort Collins; 310 S. College Ave., Fort Collins, CO 80524. City of Fort Collins, PO Box 280, Fort Collins, CO is included as additional insured as required by written contract with respect to General Liability per the terms and conditions of the policy. CERTIFICATE HOLDER CANCELLATION Sec Attachment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 15369473 AUTHORIZED REPRESENTATIVE City of Fort Collins PO Box 280 Fort Collins, CO 80522 - t ACORD 25 (2016/031 ©19$8-2 A ORD RPO N. All riahts reserved The ACORD name and logo are registered marks of ACORD