HomeMy WebLinkAbout130692 LARIMER COUNTY - INSURANCE CERTIFICATE (2)A 0a DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 5/21/2019
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.
It 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
Nathan Kathol
NAME;
Arthur J. Gallagher Risk Management Services, Inc. PH NAME:E - FAz -
6300 South Syracuse Way, Suite 700 E-MAIL 303 889-2574 At
Centennial CO 80111 ADDRESS: Nathan Kathol a' .corn
INSURER(S) AFFORDING COVERAGE _ -- NAIC #
INSURER A: Argonaut Insurance Company 19801
INSURED
Larimer County, Colorado
200 W. Oak Street INSURERC:
Suite 4000 INSURERD:
Fort Collins CO 80522 [M%UIRFRF f
r^PIVFRAnPQ rF;PTIFI('ATF NIIMRFA.ironnasFn RFVISION 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.
ildTp TYEFF ijw
ADDLr$t — POLICY NUMBER MMu YYYY MMLI D YYYYLIMITS
PE OF INSURANCE
A
X COMMERCIAL GENERAL LIABILITY -..
Y I
290201904
i 5/15/2019
5/15/2020 EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE L X _, OCCUR
DAIu kGS TbAENTED --
PREMISES jE� QpFurrgnce) --
$_—i
$
MED EXPiAy one�ersonL
$ _
$1,0D0,000
PERSONAL & ADV INJURY
GENERAL AGGREGATE
CEN'L AGGREGATE LIMIT APPLIES PER:
$
PRO-
%� POLICY JECT LOC
( PRODUCTS - COMP/OP AGG
OTHER:
A
AUTOMOBILE LIABILITY
290201904 5/15/2019 5/15/2020
COMBINED SINGLE LIMIT
a axiden _
$1,000,000
_
BODILY INJURY (Per person)
$
X ANY AUTO
(
OWNEDSCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
BODILY INJURY (Per accident)
—
PROPERTYDAMAGE
4r accident)
$
$
$
UMBRELLA LIAB `1 OCCUR
EXCESS LIAB _u CLAIMS -MADE
--D
EACH OCCURRENCE—
I $
_
AGGREGATE
_ _ _
DE RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
iNJA
PER OTH-
EA-......
E.L. EACH ACCIDENT
....
$
_
� L.L. DISEASE. E_A_E_MPLOYEE
$
It yes. describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$
I
i
I
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space is required)
The City of Fort Collins is Additional Insured as respects General Liability policy, pursuant to and subject to the policy's terms, definitions, conditions and
exclusions.
RE: Revocable Permit for Access on City property, Front Range Trail project on Flores Del Sol Natural Area
Dates: March 1, 2017 through February 28, 2018
Location: Exhibit A - The N1/2 of the SE 1/4 of Section 19, Township 6 North, Range 68 West of the 6th P.M., County of Larimer, State of Colorado. Execpting
therefrom that part conveyed to the Board of County Commissioners in Deed of Dedication recorded May 4, 1994 at Reception No. 94039129. (Vacant land, no
street address assigned.)
R
City of Fort Collins, Risk Management
PO Box 580
Fort Collins CO 80522-0580
USA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZEDREPRESENTATIVE
U 1988-2015 ACORD CORPORA I IUN. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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