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HomeMy WebLinkAbout565922 AU WORKSHOP LLC - INSURANCE CERTIFICATE (2)Client#: 1090168 AUWORLLC ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDMYYYY) 1 3/29/2019 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER USI Insurance Services, LLC P.O. BOX 7050 Englewood, CO 80155 800 873-8500 CONTACT NAME: _ HEN o Ea 800 873-8500 A/C No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Sentinel Insurance Company Ltd. 11000 INSURED hop, IIC 05 L 405 Linden St INSURER B • Hartford ins Cc of the Midwest 37478 INSURER C XLSpeclaltyinsurance Company 37885 Fort Collins, CO 80524 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. LTRR TYPE OF INSURANCE NSRLSUBR WVD POLICY NUMBER MM/DD/YYYF MM/DDNEXP LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 34SBWPP2901 1 /01 /2018 11/01/2019 EACH OCECCURRENCE $1,000,000 CLAIMS -MADE 1 ^ 1 OCCUR PREMISES (Ea RENTED ) $1 000 000 MED EXP (Any one person) $10 000 PERSONAL BADVINJURY $1,000,000 _ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY � ECOT I7 LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 $ OTHER: A AUTOMOBILE LIABILITY Y Y 34SBWPP2901 1/01/2018 11/01/201 (CEO, accMccdenLINGLELIMIT ident 1,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED X AUTOS ONLY I X AUTOS ONLY $ PROPERTY DAMAGE Per accident A X UMBRELLA LIAB X OCCUR Y Y 34SBWPP2901 1/01/2018 11/01/2019 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 EXCESS UAB CLAIMS -MADE DIEDXil RETENTION $10 000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N OFFICER/MEMBER EXCLUDED? N/A Y 34WECAA0595 3/08/2019 03/08/202 X PER OTH- T T TER E.L. EACH ACCIDENT $100000 $1%) OOO (Mandatory in NH) E.L- DISEASE - EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT 1 $500,000 C Professional DPR9940442 4/12/2019 04/12/2020 $1,000,000 per claim Liability $2,000,000 annl aggr. Claims Made DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) As required by written contract or written agreement, the following provisions apply subject to the policy terms, conditions, limitations and exclusions: The Certificate Holder and owner are included as Automatic Additional Insured's for ongoing and completed operations under General Liability; Designated Insured under Automobile Liability; and Additional Insureds under Umbrella / Excess Liability but only with respect to liability arising out of the Named Insured work performed on behalf of the certificate holder and owner. (See Attached Descriptions) L.Cr1 I Irii-A 1 C mULUr-r1 City of Fort Collins 300 Laporte Ave Fort Collins, CO 80524 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 ACORD 25 (2016/03) 1 of 2 #S25357181/M25330228 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD USBZP