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HomeMy WebLinkAbout102747 JAX OUTDOOR GEAR - INSURANCE CERTIFICATE (3)A`CO�RO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/2018 ) 12l31 /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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Kylie Carey, CISR, CIC NAME: PHONE (970) 266-7148 FAx (970) 506-6845 AIC No Ezt : A/C No): Flood and Peterson E-MAIL KCarey@floodpeterson.com ADDRESS: PO Box 578 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA : Westfield Insurance Company 24112 Greeley CO 80632 INSURED INSURER B : Cincinnati Insurance Co 10677 INSURER C : Plnnacol Assurance 41190 Jax, Inc. INSURER D : Zurich American Insurance Company 16535 P.O. Box 469 INSURER E : INSURER F : Bellvue CO 80512 COVERAGES CERTIFICATE NUMBER: Full Cert x 01/01/2020 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 INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR DAMAGE TO RENTED PREMISES Ea occurrence)$ 500,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY S 1,000,000 A CMM010336C 01/01/2019 01/01/2020 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000O- PRODUCTS - COMP/OPAGG $ 2,000,000 POLICY PRO � LOC J PERLO $ OTHER. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident s 1,000,000 BODILY INJURY (Per person) $ ANYAUTO BODILY INJURY(Per accident) $ AOWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY IX CMM 010336C 01/01/2019 01/01/2020 PROPERTY DAMAGE Per accident $ Uninsured motorist s 1,000,000 X UMBRELLA LIAR X OCCUR —u uWEN E"'" EACH OCCURRENCE S 5,000,000 B EXCESS LIAB CLAIMS -MADE EUP0518721 01/01/2019 01/01/2020 AGGREGATE s 5,000,000 DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ONEXCLUDED? (Mandatory in NH) NIA 4161344 01/01/2019 01/O1/2020 OTH- X STATUTE ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE- EA EMPLOYEE S 500'000 E.L. DISEASE - POLICY LIMIT $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below D Workers' Compensation - OSC - IA WC969190006 01/01/2019 01/01/2020 500,000/500,000/500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins is included as Additional Insured as required by written contract with respects to General Liability arising out of work performed by the named insured. CFRTIFICATF HOLDER CANCELLATION City of Fort Collins P.O. Box 580 Fort Collins CO 80522-0000 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD