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�'' DATE (MM; DD/YYYY)
, llla K_ �' CERTIFICATE OF LIABILITY INSURANCE
06/2$/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:
Willis of Texas, Inc. --FAX
c/o 26 Century Blvd PHONE 1-B77-945-7378 A/C No: 1-888-467-2378
P.O. Box 305191 E-MAILcertificatea@veillie.com
Nashville, TN 372305191 USA INSURERS ) AFFORDING COVERAGE NAIC Jt
INSURER A: Greenwich Insurance Company 22322
INSURED
HCBeck, Ltd.
1807 Ross Avenue
Suite 500
Dallas, TX 75201
INSURERB: RSUI Indemnity Company 1 22314
INSURERC: XL Specialty Insurance Company 37885
INSURERD: XL Insurance America Inc 24554
COVERAGES CERTIFICATE NUMBER, W11883457 RFvISInN NIIMRFR•
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,
ILTR TYPE OF INSURANCE ADDLiSU POh►CY NUMBER MM DDrYYYY M luDD VYYY ' LIMITS
X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000, 000
A
CLAIMS -MADE � OCCUR
I
N
PREMISES LEa_pcarre_nc_-
EM D EXP (An one e,son)
$ 100,000
$ 5, 000
PERSONAL & ADV INJURY
$ 1,000,000
CGC7409866 07/01/2019
07/01/2020
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
--- -
PRO•—..--.
POLICY X JECT LOC
---
PRODUCTS -COMP%OP RGG
S 2,000,000
$
OTHER:
I
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
000
$ 1,000,000
BODILY INJURY (Per person)
$
X ANY AUTO
A
OWNED SCHEDULED
AUTOS ONLY AUTOS
CAH7409867 07/01/2019
07/01/2020
BODILY INJURY (Per accident)
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
H
X
UMBRELLA LIAS X OCCUR
EACHOCCURRENCE
$ 10,000,000
AGGREGATE
is 10,000,000
iEXCESSLIAB CLAIMS -MADE
NgA086732,07/01/2019
07/01/2020
DED RETENTIONS
$
WORKERS COMPENSATION
LIABILITY
AND EMPLOYERS' OFFICER/MEMBEREXCLUDED7
C �Me d OryI�TNH�PAR'iNER/EXECUTIVE Y❑
NIA'
CWC7409865 07/01/2019
X STATUTE OT
ER
07/01/2020' -..... - -----
E.L DISEASE ASE�EAENT
I
.__ 1,000,000
$EMPLOYEE $- 1,000,000
II yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
D Izcesa Liability - 2nd Layer
US00071617LI19A 07/01/2019
07/01/2020 lach Occurrence
1010,000,000
i
(Aggregate
$10,000,000
DESCRIPTION OF OPERATIONS,'LOCATIONS' VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required)
l.trf 1 Ir-II.A I t r1VLUtH UANd.tLLA 1IVN
City of Fort Collins
Contractor Licensing
281 N. College Ave.
Vt. Colling, CO 80526
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
WJ I.7Do-cv IQ MNVIIv
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
sR ID; 18182445 BATcH: 1264149
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