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HomeMy WebLinkAboutCORRESPONDENCE - RFP - 8107 ATHLETIC FIELD SCOREBOARDSSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME: CONTACT (A/C, No): FAX E-MAIL ADDRESS: PRODUCER (A/C, No, Ext): PHONE INSURED COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ PROPERTY DAMAGE $ BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOS ONLY AUTOS NON-OWNED OWNED SCHEDULED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: 2 2 Atlanta TC2NUB-9D90031-4-18 (AL CO GA IA IL IN KS KY MD MI MO MT NC NE NV NY OK PA SC TN TX UT) � TROUB-9D90032-6-18 (AZ, FL, OR, WI, MA)� �� UB-7J602089-18-14-G (AZ CA CO CT FL GA ID IL IN KS MD MN MO MT NC NH NV NY OK OR PA TN TX WV)� �� �� � Workers' Compensation (Continued): � Certificate of Liability Insurance CN102326389 Marsh USA, Inc.� dba Colorado Time Systems, Inc.� Everlast Climbing Industries, Inc.� Loveland, CO 80537 1551 E. 11th St.� 25 (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT ER OTH- STATUTE PER (MM/DD/YYYY) LIMITS POLICY EXP (MM/DD/YYYY) POLICY EFF LTR TYPE OF INSURANCE POLICY NUMBER INSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB EACH OCCURRENCE $ AGGREGATE $ $ OCCUR CLAIMS-MADE DED RETENTION $ PRODUCTS - COMP/OP AGG $ GENERAL AGGREGATE $ PERSONAL & ADV INJURY $ MED EXP (Any one person) $ EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY C 2,000,000 08/01/2019 G2821800A 002 Manashi Mukherjee UB-7J602089-18-14-G 10,000,000 ATL-004365421-20 1,000,000 25,000,000 TC2NUB-9D90031-4-18 X 25674 25,000,000 Aggregate of Marsh USA Inc. Atlanta, GA 30326 N X Comp/Coll Ded: $1,000 SIR $10,000 Per Occ. 08/01/2018 Liberty Surplus Insurance Corp 9 08/01/2019 08/01/2018 25623 08/01/2019 TJ-CAP-9D897065TIL-18 Excess Umbrella B 4,000,000 2,000,000 (See Additional Page.) 19445 Travelers Property Casualty Company Of America 1,000,000 X E written contract. 07/31/2018 25,000,000 08/01/2018 25,000,000 08/01/2018 Re: RFP 8107 - Athletic Field Scoreboards City of Fort Collins is listed as additional insured as their interests may appear, during and until completion of the project, on a primary and non-contributory basis, on the General Liability via CG 2010 & CG 2037 X 08/01/2018 POLICY AGGREGATE Fort Collins, CO 80522 City of Fort Collins Phoenix Insurance Company 10,000 and Automobile Liability via CA T4 37 08 08 policies, as required by written contract. A Waiver of Subrogation applies in favor of the additional insureds on the Workers Compensation policy, where required by X A B National Union Fire Insurance Co. of Pittsburgh, PA CN102326389-CTS-GAUWX-18-19 Each Occurrence EXCLUDED 08/01/2019 1,000,000 BE 014788208 D 4,000,000 10030 100,000 1,000,000 08/01/2019 TROUB-9D90032-6-18 Two Alliance Center Marsh USA, Inc. X 3560 Lenox Road, Suite 2400 Attn: Atlanta.CertRequest@marsh.com / Fax: 212-948-4321 X dba Colorado Time Systems, Inc. Everlast Climbing Industries, Inc. Loveland, CO 80537 1551 E. 11th St. X X 1000054456-08 08/01/2018 PO Box 580 08/01/2018 B 08/01/2019 10725 08/01/2019 Westchester Fire Insurance Company