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HomeMy WebLinkAbout439705 BELFORD WATKINS GROUP LLC - INSURANCE CERTIFICATE (14)Client#: 1083601 BELFOWAT ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 3/14/2019 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 PHONE g00 873-8500 FAX A/C No Ext : A/C, No P.O. Box 7050 E-MAIL Englewood, CO 80155 ADDRESS: --- INSURER(S) AFFORDING COVERAGE NAIC # 800 873-8500 INSURER A: Saminsl Insurance Company Ltd. 11000 INSURED INSURER B:xLspselaltyInsurance company 37885 Belford Watkins Group, LLC PO Box 1306, Fort Collins, CO 80522 INSURER C : 425 W. Mulberry Street, Suite 207 INSURERD: Fort Collins, CO 80521 INSURERS: 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. LTR TYPE OF INSURANCE DLSUBR ISR NSR WVD POLICY NUMBER MM/DCDY EFF MMfDDIYYM (POLICY EXP LIMITS A X1 COMMERCIAL GENERAL LIABILITY 34SBAPM7802 7/08/2018 07/08/2019 OCCURRENCE $1,000,000 CLAIMS -MADE ❑X OCCUR PEACH PREMIs S EaE�urrrence $1,000,000 MED EXP (Any one person) $10 000 PERSONAL & ADV INJURY $1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER, PRO - POLICY � ECT LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY 34SBAPM7802 7/08/2018 07/08/201 COMBINED SINGLE LIMIT Ea accident 1,000,000 BODILY INJURY (Per person) $ ANY AUTO X OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY X NON -OWNED AUTOS ONLY BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ A X UMBRELLA LIAB X I OCCUR 34SBAPM7802 7/08/2018 0710812019 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 EXCESS LIAR CLAIMS -MADE DED X RETENTION $10000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? N / A PER I OTH- ISTATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ B Professional DPS9939754 0311512119 03/15/2021 $1,000,000 per claim Liability $1,000,000 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) City of Fort Collins 215 N Mason Fort Collins, CO 80522 GANGtLLAI IVN 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 (2016103) 1 of 2 #S25206000/M25203363 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SKUZP