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HomeMy WebLinkAbout109005 POUDRE VALLEY AIR OF NORTHERN COLORADO INC - INSURANCE CERTIFICATE (2)ACOR" CERTIFICATE OF LIABILITY INSURANCE I1"1 DATE (MM DD YYVV) 1 09/19/2019 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 AICONNo Ex : (970) 356-0123 FAQ NII: (970) 330-1867 E-MAIL SKammerer@Aoodpeterson.com ADDRESS: PO Box 578 INSURER(S) AFFORDING COVERAGE NAIC k INSURER A: Employers Mutual Casualty Company 21415 Greeley CO 80632 INSURED INSURERS., Plnnacol 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 r'nVFRAr:FS I^_ERTIFICATE NUMBER- x10/17/19-20 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. I�TR TYPE OF INSURANCE INSD YVVD POLICY NUMBER MM DD//YYYY MM/DDIVYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX1 OCCUR I 5X77586 10/17/2019 10/17/2020 EACH OCCURRENCE $ 1,000.000 DAMAGE TO RENTIT17- PREMISES Ea occurrence $ 500,000 _7 MED EXP (Anyone person) $ 10,000 PERSONAL B ADV INJURY $ 1.000,000 GEN'LAGGREGATE LIMITAPPLIES PER: POLICY © JECOT 7 LOC OTHER GENERAL AGGREGATE $ 2.000.000 PRODUCTS - COMP/OP AGO $ 2,000,000 $ A AUTOMOBILE LIABILITY X ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY 5X77586 10/17/2019 10/17/2020 COMBINED SINGLE LIMIT Ea accident $ 1.000.000 BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ Uninsured motorist $ 1,000,000 A UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 5X77586 10/17/2019 10/17/2020 ..... &..��.......'RA"..�..... EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,000 DED X RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LUIBILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERMEMBER EXCLUDED? FN7 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 4074340 07/Ol/2019 07/01/2020 X STA UTE ERA E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 El. DISEASE - POLICY LIMIT $ 1,000,000 7 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) 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 I lckly Cc119AA-2015 ACORD CORPORATION_ All rights reserved ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD