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Home My WebLink About109005 POUDRE VALLEY AIR OF NORTHERN COLORADO INC - INSURANCE CERTIFICATEA�RD® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/OD/YYYY) 06111/2019 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 Shannon Kammerer NAME: Flood and Peterson PHONE (g70) 356-0123 FAX (970) 330-1867 A/C No Ext : A/C No EMAIL SKammerer@floodpeterson.com ADDRESS: PO Box 578 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Employers Mutual Casualty Company 21415 Greeley CO 80632 INSURED INSURER B : Plnnacoi Assurance 41190 INSURER C Poudre Valley Air of Northern INSURER D : Colorado, Inc INSURER E : 2416 Donella Court, Suite A INSURER F : Fort Collins CO 80524 rOVFRCGFS CERTIFICATE NUMBER: x10/17/18-19 Master 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 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. IICY LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER EXP MM/DD/YYYYLIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE ®OCCUR rOMIDD DAMAGE TO RENTE7_ PREMISES Ea occurrence SOO,000 S MED EXP (Any one person) S 10,000 A 5X77586 10/17/2019 PERSONAL aADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 21000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY ©JE LOC $ OTHER, AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident g 1,000,000 BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) S A OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY 5X77586 10/17/2018 10/17/2019 PROPERTY DAMAGE Per accident $ Uninsured motorist $ 1,000,000 11 UMBRELLA LIAB OCCUR � ", EACH OCCURRENCE 3,000,000 $ AGGREGATE $ 3,000,000 A EXCESS LIAB CLAIMS -MADE 5X77586 10/17/2018 10/17/2019 DED I X RETENTION $ 0 S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) N /A 4074340 07(O1/2019 O7l01/2020 X1 STATUTE I ERH E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE 1,000,000 $ E.L. DISEASE - POLICY LIMIT 1,000,000 $ If yes describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) V NIYV GL LMI IVI� SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins Home Efficiency Program ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 AUTHORIZED REPRESENTATIVE Fort Collins CO 80522 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD