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HomeMy WebLinkAbout456276 MUNICIPAL CODE COMPLIANCE - INSURANCE CERTIFICATEClient#: 764169 68MUNICCOD1 ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/OD/YYYY) 1 12/28/2018 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(les) 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 McGriff Insurance Services, Inc. 3375-B Capital Circle, NE NONEACT Stacy Rouslin PHONi 850-205-7039 FAX A/C No Ext : A/c No): 888-328-1326 ADDRESS: srouslin@bbandt.com PO Box 14099 Tallahassee, FL 32317 -_-- INSURER(S) AFFORDING COVERAGE NAIC N INSURER A:CaronentalMau- CompanyAXV 35289 INSURED Municipal Code Corporation P.O. Box 2235 INSURER B : Valley Forge Insumnee Company ARV 20508 INSURER C Tallahassee, FL 32316 INSURER D INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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 - - ADDLSUB LTR TYPE OF INSURANCE POLICY NUMBER_.- _ POLICYEFF POLICYEXP-- fI M/DD/YYY1J' MM/DD LIMITS _ A X1 COMMERCIAL GENERAL LIABILITY X X 6056730134 1 /01 /2019 01 /01 /2020 EACH OCCURRENCE $1 000,000 -�-- - CLAIMS -MADE a OCCUR DAMAGE T RENTED PREMISES Ea occurrence $300OOO MED EXP (Any one person) $15i000 PERSONAL& ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY C'. ECT LOC PRODUCTS - COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY X X 6056730098 1/01/2019 01/01/202 COMBINED SINGLE LIMIT Ea accident 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY _ x X BODILY INJURY (Per accident) $ PROPERTYDAMAGE eracddent $ $ UMBRELLA LIAB X J OCCUR '6056730151 1/01/2019 A X X X 01/01/2020 EACH OCCURRENCE $5000,000 AGGREGATE $5,000,000 EXCESS LIAB CLAIMS -MADE $ DED X RETENTION $1 O 000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE nY / N OFFICER/MEMBER EXCLUDED? LJ (Mandatory In NH) N / A X WC656730120 1/01/2019 01/01/202 X PER OTH- ER E.L. EACH ACCIDENT $500OOO E.L. DISEASE - EA EMPLOYEE $500OOO E.L. DISEASE - POLICY LIMIT $500,000 If yes, describe under DESCRIPTION OF OPERATIONS below B CA work comp X _ _ WC6056730117 1/01/2019 01/01/202� $1,000/51,000/31,000 A Professional Liab 596858955 2/09/2019 �2/09/2019 02/09/202 $2,000,000 A C ber Liability 596858955 02/09/2022 $2 000 000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Add [tic naI Remarks Schedule, may be attached If more space Is required) ** Workers Comp Information ** Other States Coverage Blanket Waiver of Subrogation ** General Liability, Commercial Auto and Excess Liability Blanket Waiver of Subrogation, Blanket Additional Insured (See Attached Descriptions) 1 It HULUtH: City of Fort Collins, CO 215 North Mason, 2nd Floor Fort Collins, CO 80522 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 t)6.4 SLV-e, ACORD 25 (2016/03) 1 of 2 #S22645033/M22594934 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR9 DESCRIPTIONS (Continued from Page 1) ** Supplemental Name ** AHA Consulting, Inc. 26-2674611, MCCI 1958 LLC 47-1788012, Agenda Pal Corporation City of Fort Collins, CO is listed as additional insured with regards to liability. SAGITTA 25.3 (2016/03) 2 of 2 #S22645033/M22594934