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HomeMy WebLinkAboutCOGENT INC - INSURANCE CERTIFICATE (2)AC O® CERTIFICATE OF LIABILITY INSURANCE DATE0(MM D01) 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 endorsement(s). PRODUCER Aon Risk Services Central, Inc. Chicago IL Office CONTACT NAME: (aCO.NNo. Ext): (866) 283-7122 A/C. No.): (800) 363-0105 E-MAIL ADDRESS: 200 East Randolph Chicago IL 60601 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: American Zurich Ins Co 40142 Cogent, Inc, Automatic Enoineerino. Fluid Equipment, LLC, BRI, Catalyst, Liberty Facility, LLC, IME Solutions, INSURER B: Zurich American Ins Co 16535 INSURER C: Travelers Property Cas Co of America 25674 INSURER D: Lee Mathews, vanco, Vandevanter Enggineering, water Technology Group INSURER E: 318 Broadway St. Kansas city MO 64105 USA INSURER F: COVERAGES CERTIFICATE NUMBER: 570075740508 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. Limits shown are as requested INSR TR TYPE OF INSURANCE ADDL INSD SUER WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY GLOl 4 1 EACH OCCURRENCE $1, OOO, OOO CLAIMS -MADE X❑ OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 500 , 000 MED EXP (Any one person) $10 , 000 PERSONAL &ADV INJURY $1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $2 , 000 , 000 X POLICY ❑ PRO ❑ JECT LOC PRODUCTS - COMP/OPAGG $2,000.000 OTHER: B B AUTOMOBILE LIABILITY BAP 1060783-02 BAP 1060784-02 04/01/2019 04/01/2019 04/01/2020 04/01/2020 COMBINED SINGLE LIMIT Ea accident $1, 000 , 000 BODILY INJURY ( Per person) ANYAUTO BODILY INJURY (Per accident) XIOWNED SCHEDULED AUTOS ONLY AUTOS X HIREDAUTOS X NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE Per accident C X UMBRELLA LIAB X OCCUR ZUP16N4815419NF 04/01/2019 04/01/2020 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS -MADE EX Follow Form & umbrella AGGREGATE $10,000,000 DED I RETENTION A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE wc106078102 04/01/2019 04/01/2020 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $1 , 000 , 000 N OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) N / A E.L. DISEASE -EA EMPLOYEE $1 , 000 , 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1 , 000 , 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Fort Collins are included as Additional insured in accordance with the policy provisions of the General Liability and Automobile Liability policies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. The City of Fort Collins AUTHORIZED REPRESENTATIVE Purchasing Department PO Box 580 Fort Collins CO 80522 USA �}q!�raa i=��:rd/c cJct�esr�r0 E�n�L�G `/na OD 0 Cn V LO 0 0 r- In ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD General Liability Extended Coverages 0 ZURICH Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. 1 Producer No. Add]. Prem Return Prem. G LO1060782-02 4/1 /2019 4/1 /2020 4/1 /2019 30-380000 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part The following changes apply to this Coverage Part. A. Fellow Employee And Incidental Medical Malpractice Coverage Paragraph 2.a.(1) of Section II — Who Is An Insured is replaced by the following: 2. Each of the following is also an insured: a. Your "volunteer workers" only while performing duties related to the conduct of your business, or your "employees", other than either your "executive officers" (if you are an organization other than a partnership, joint venture or limited liability company) or your managers (if you are a limited liability company), but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business. However, none of these "employees" or "volunteer workers" are insureds for: (1) "Bodily injury" or "personal and advertising injury": (a) To you, to your partners or members (if you are a partnership or joint venture) or to your members (if you are a limited liability company); (b) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraph (1)(a) above; or (c) Arising out of his or her providing or failing to provide professional health care services, except any "bodily injury" or "personal and advertising injury" arising out of: (1) Medical or paramedical services to persons performed by any physician, dentist, nurse, emergency medical technician, paramedic or other licensed medical care person employed by you to provide such services; or (2) Emergency cardiopulmonary resuscitation (CPR) or first aid services performed by any other employee of yours who is not a licensed medical professional. B. Additional Insureds— Lessees Of Premises 1. Section II — Who Is An Insured is amended to include as an additional insured any person or organization who leases or rents a part of the premises you own or manage who you are required to add as an additional insured on this policy under a written contract or written agreement, but only with respect to liability arising out of your ownership, maintenance or repair of that part of the premises which is not reserved for the exclusive use or occupancy of such person or organization or any other tenant or lessee. However, the insurance afforded to such additional insured: Only applies to the extent permitted by law; b. Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured; and c. Ends when the person or organization ceases to lease or rent premises from you. U-GL-1477-B CW (04/13) Page 1 of 9 Includes copyrighted material of Insurance Services Office, Inc. with its permission.