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HomeMy WebLinkAbout113275 ALM2S - INSURANCE CERTIFICATEALM2S-1 OP ID: B3 DATE(MM/DD/YYYY) 03/26/2019 ACORO CERTIFICATE OF LIABILITY INSURANCE �� 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 endorsements . PRODUCER 970-482-7747 CONTACT Karen E. Siwek, CPA Brown & Brown Inc PHONE FAX 4532 Boardwalk Dr, Suite 200 (A/C, No, Ext): 970-482-774T (A/C, No :970-484-4165 Fort Collins, CO 80525 ADD IL slwe co ora o.com Karen E. Siwek, CPA INSURERS AFFORDING COVERAGE NAIC p INSURER A: Pinnacol Assurance Company 41190 INSURED alm2s 712 Whalers Way, Ste. B-100 Fort Collins, CO 80525 INSURER B : Westfield Insurance Company 24112 INSURER C : Admiral Insurance Company24856 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 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 TYPE OF INSURANCE DDL UBR POLICY NUMBER POLICY EFF POLICY EXP IMMIDDIYYYYI LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR Y BOP3719966 04/01/2019 04/01/2020 DAMAGETOrurne100,000 MED EXP Any one erson 5,000 X EBL/EPL PERSONAL & ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ JECT E] LOC GENERAL AGGREGATE 2,000,000 PRODUCTS - COMP/OP AGG 2,000,000 Emp Ben. 1,000,000 OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY Per person)$ X ANY AUTO Y BOP3719966 04101/2019 04/01/2020 _ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ PPerOa Ecc'IRdent AMAGE $ _ AUTOS ONLY AUUTOS ONLYY B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE 2,000,000 AGGREGATE $ 2,000,600 EXCESS LAB CLAIMS -MADE BOP3719966 04/01/2019 04/01/2020 DED I X I RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE �Y / N FFFIC Rory in NH) EXCLUDED? ' •- N / A. 1951272 04/01/2019 04/01/2020 X I STAT T ERH E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYE 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 If Yes, describe under DESCRIPTION OF OPERATIONS below C Professional E0000037269-03 04/01/2019 04/01/2020 Ea Claim 2,000,000 i Aggregate 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) RE: Park Architectural Services On -Call City of Fort Collins, its officers, agents and employees shall be included as additional insured with respect to General Liability and Automobile Liability per policy forms and conditions on page 2. 30Day Notice of Cancellation applies to General Liability and Automobile Liability. CITYFC2 City of Fort Collins PO Box 580 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 Karen E. Siwek, CPA ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NOTEPAD alm2s ALM2S-1 PAGE 2 INSUREWS NAME OP ID: B3 Date 03/26/2019 When required by written contract the following applies: Blanket Additional Insured BP 0451 Primary and Non -Contributory BP 1488 Blanket Waiver of Subrogation BP 0497 Additional Insured - State or Governmental Agency or Subdivision or Political Subdivision - Permits or Authorization Relating to Premises BP 0407 Blanket Additional Insured - Owners. Lessees or Contractors with Additional Insured Requirements for Parties in Construction Contract - BP 0451 Automobile - Blanket Additional Insured CA 7078 Blanket Waiver of Subrogation CA 0444 Umbrella - Following Form Workers Compensation - Blanket Waiver of Subrogation 359-B