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HomeMy WebLinkAbout565922 AU WORKSHOP LLC - INSURANCE CERTIFICATE (3)Client#: 1090168 AUWORLLC ACORDT. CERTIFICATE OF LIABILITY INSURANCE DATE(MM,,DD,'YYYY) 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 CONTACT NAME: USI Insurance Services, LLC HONE 800 873-8500 P.O. Box 7050 Exf : ac, No E-MAIL Englewood, CO 80155 ADDRESS:_ 800 873-8500 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Sentinel Insurance Company Ltd. 11000 INSURED INSURER B : Hartford Ins co of the Midwest 37478 [au]workshop, Ilc INSURER C • XL Specialty Insurance Company 37885 405 Linden St INSURER D Fort Collins, CO 80524 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, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ggEXCLUSIONS LTRR TYPE OF INSURANCE COMMERCIAL GENERAL LIABILITY XIEEAAqC,,�H��OEECCURRENCE CLAIMS -MADE LJ OCCUR !NSR Y W D!ADDLSUBR Y POLICY NUMBER MM/DIDNYYY MM/DD/YYYY LIMITS A X 34SBWPP2901 11/01/2018 11/01/2019 $_1 000000 PREMISESaoccurrence $1,000,000 MED EXP (Any one person) $1 O 000 PERSONAL& ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY L^ JECTT 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 COMBdent SINGLE Ea accident 1,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY BODILY INJURY (Per accident) $ PROPERTYDAMAGE Per accident $ A X, UMBRELLA LIAB X OCCUR Y Y 34SBWPP2901 11/01/2018 11/01/2019 EACH OCCURRENCE $1 000000 AGGREGATE $1,000,000 EXCESS LIAB CLAIMS -MADE DED I X RETENTION$10000 $ 1 1 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITYER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N OFFICER/MEMBER EXCLUDED? N/A Y 34WECAA0595 3/08/2019 03/08/202 X PER OTH- E.L. EACH ACCIDENT $100000 E.L. DISEASE - EA EMPLOYEEI $100000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below_ DPR9940442 E.L. DISEASE -POLICY LIMIT 1 $500,000 $1,000,000 per claim C Professional 4/12/2019 04/12/202 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) ULUCrt City of Fort Collins PO Box 580 Fort Collins, CO 80522-0580 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 #S25357180/M25330228 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD USBZP