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HomeMy WebLinkAbout366358 JVA INC - INSURANCE CERTIFICATE (3)Client#: 1083121 JVAINC ACORDT. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDiYYYY) 5/06/2019 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: PHONE g00 873-8500 AC No Ext : A/C No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIL # INSURER A: Travelers Indemnlry Company 25656 INSURED JVA, Inc. 1319 Spruce Street Boulder, CO 80302 INSURER B : Travelers Property Cos. Co. of Amwlce 25674 41190 PlacolAssurance Company INSURER C nn INSURER D • %L specialty Insurance Company ' 37865 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MMOD LIMBS A X COMMERCIAL GENERAL LIABILITY X X 6809H706548 5/01/2019 05/01/2020 EACH��OEECCURRENCE s2,000,000 CLAIMS -MADE OCCUR PREMISESOEaoccurrence $1 000 000 MED EXP (Any one person) $10 000 PERSONAL & ADV INJURY $2,000,000 GEN L AGGREGATE LIMIT APPLIES PER: POLICY FXI JECOT- El LOC GENERAL AGGREGATE $4,000 000 PRODUCTS - COMP/OP AGG s4,000,000 $ OTHER: B AUTOMOBILE LIABILRY X X BA1696L578 5/01 /2019 05/01 /202 COMBINED SINGLE LIMIT Ea accident 1r 000,000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY X BODILY INJURY (Per accident) $ $ PROPERTY DAMAGE Per accident B X UMBRELLA LIAB OCCUR X X CUPSG343469 05/011/2019'05/011/2020 EACH OCCURRENCE $$ 000 000 AGGREGATE _ $6 000.000 EXCESS LIAR CLAIMS -MADE DED X RETENTION $10000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A X 4131403 5/01 /2019 05/01 /202 OTH- X ATEARTuTE E.L. EACH ACCIDENT $1 NO 000 E.L. DISEASE - EA EMPLOYEE $1 000 000 Ups , describe under DCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000 000 D Professional X DPR9941906 5/01/2019 05/01/2020 $5,000,000 per claim Liability $5,000,000 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 Operation Services 300 LaPorte Ave., Building B Fort Collins, CO 80521-0000 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 #S25625490/M25606336 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BYPZP