HomeMy WebLinkAbout102722 JUPITER I LLC DBA OFFICESCAPES - INSURANCE CERTIFICATE (4)CERTIFICATE OF LIABILITY INSURANCE r
ATE(MM/DDNYYY)
�---�' 3/1/2019
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 rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME: Cynthia Bad e
USI Insurance Services Arc No): 303-831-5295
P.O. Box 7050 A o No • 800-873-8500 FAx
EnEnglewood CO 80155 E-MAIL
9 ADDRESS: Den.certificate(a)usi.com
INSURERS AFFORDING COVERAGE NAIC #
INSURERA: Zurich American Insurance Company 16535
INSURED JUPITI INSURER B : St Paul Fire and Marine Insurance Co 24767
Jupiter I, L.L.C. dba OfficeScapes
4950 S. College Ave., Unit A INSURERC:
Fort Collins, CO 80525 INSURERD:
INSURER E :
COVFRAnFR CFRTIFIr`ATF All IMriCD• aonnnn7oc
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
LTR
TYPE OF INSURANCEINSD
ADDL SUBR
WVQPOLICY
NUMBER
POLICY EFF
MM/DD/YYYY MM/ D1 EXP
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE X1 OCCUR
Y
Y
GLO980918305
3/1/2019
3/1/2020
EACH OCCURRENCE
$1,000,000
DAMAGE TO PREMISES Ea occE ence
$ 300,000
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
GEN'❑ L AGGREGATE LIMIT APPLIES PER:
X PRO
�I POLICY JECT LOC
GENERAL AGGREGATE
$2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
OTHER
A
AUTOMOBILE LIABILITY
X ANY AUTO
Y
Y
BAP980918405
3/1/2019
3/1/2020
COMBINED SINGLE LIMIT
Ea accident
$1,000,000
BODILY INJURY (Per person)
$
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
---
$
X HIRED EXNON-OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
Per accident
$
B
X
UMBRELLALIAB
I X
OCCUR
Y
Y
ZUP11S1702019NF
3/1/2019
3/1/2020
EACH OCCURRENCE
$5,000,000
AGGREGATE
$ 5,000,000
EXCESS LIAB
CLAIMS -MADE
DED I X I RETENTION $ 1 ri nnn
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANYPROPRI ETOR/PARTN ER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑
Y
N / A
WC980918205
3/1/2019
3/1/2020
X PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
(Mandatory in NH)
If yes, describe under
E.L. DISEASE - POLICY LIMIT
DESCRIPTION OF OPERATIONS below
$ 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Project: 8230 Moving Support Services
Additional Insured per written notice or contract to General Liability: The City of Fort Collins, Colorado, a Municipal Corporation, its officers, agents and
employees
The City of Fort Collins, a Municipal Corporation
Attn: Director of Purchasing & Risk Management
P.O. Box 580
Fort Collins CO 80522
11WN
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
*6
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