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HomeMy WebLinkAbout102925 MOUNTAIN STATES EMPLOYERS COUNCIL INC - INSURANCE CERTIFICATEClient#: 1084940 MOUNTSTA15 DATE (MM/DD/YYYY) ACORD. CERTIFICATE OF LIABILITY INSURANCE 7/08/2019 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 CONTACT NAME: USI Insurance Services, LLC PHONE 800 873-8500FAX Alc No Et): A/C No): P.O. Box 7050 E-MAIL Englewood, CO 80155 ADDRESS: 800 873-8500 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A • phoenix Insurance Company 25623 INSURED Mountain States Employers Council, Inc. Employers Council Services, Inc. 1799 Pennsylvania St. Denver, CO 80203 INSURER B • Travelers Indemnity Company 25658 INSURER C : Pinnaeol Assuramw Company 41190 INSURER D : Indian Harbor Insurance Company 36940 INSURER E : COVERAGES CERTIFICATE NUMBER: REVISION NUMRFR- 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. LTR TYPE OF INSURANCE INSRLSUBR WVD POLICY NUMBER MMIDICDY EFF MMIDQ EXP LIMITS A X COMMERCIAL GENERAL LIABILITY x x 6809E4474551942 7/15/2019 07/1512020 EACH $1 00O 000 CLAIMS -MADE `_ XI OCCUR $300000 q�OCCURRENCE PREMISES &a N.TLrrence MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY JECT 7 LOC GENERAL AGGREGATE $2,000,000 x PRODUCTS - COMP/OP AGG $2,000,000 $ _ OTHER: 'i B AUTOMOBILE LIABILITY x x BA9E45007819SEL 7/15/2019 07/15/202 COMBINED SINGLE LIMIT Ea accident 1 rO00r000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY X BODILY INJURY (Par accident) $ PROPERTY DAMAGE Per accident $ _ $ X Drive Oth Car B X UMBRELLA LIAR X OCCUR x CUP9E4505151942 7/15/2019 07/15/2020 EACH OCCURRENCE $8 000 000 AGGREGATE $8 00O 000 EXCESS LIAB CLAIMS -MADE DEC) I X RETENTION $10000 $ C' WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? N] NIA x 4046690 7/01/2019 07/01/202 PER OTH- X E.L. EACH ACCIDENT $1 000 000 E.L. DISEASE - EA EMPLOYEE $1 000 000 l (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1 ,000,000 D Professional MPP004161006 7/15/2019107/151202 Each Claim: 3,000,000 Liability I Aggregate: 5,000,000 Claims Made Ded. Per Claim 50,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) If required by written contract or written agreement, the following provisions apply subject to the policy terms, conditions, limitations and exclusions: The Certificate Holder is included as Automatic Additional Insured's for General Liability and Designated Insured under Automobile Liability but only with respect to liability arising out of the Named Insureds work performed on behalf of the certificate holder. This General Liability policy will apply on a primary basis. A Blanket Waiver of Subrogation applies (See Attached Descriptions) IiCR i iri%,A I C MULUMIN City of Fort Collins Attn: Gerry Paul; Purchasing Dept. P.O. Box 580 Fort Collins, CO 80522 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 #S26117383/M26113485 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD S9KZP