HomeMy WebLinkAbout565922 AU WORKSHOP LLC - INSURANCE CERTIFICATE (4)Client*- 11190168
AUWORLLC
ACORD. CERTIFICATE OF LIABILITY INSURANCE
DATE11/08/2019 V)
F
8/2019
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 pollcy(les) 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)._ _
R-
PRODUCE.
-__... __ - - ___.
NAME:
US[ Insurance Services, LLC
P.O. Box 7050
Englewood, CO 80155
BOO 873-8SOO
PAH/COHN En : 800 873 850.0 ac No :
E-MAIL
ADDRESS:
INSURER(S) AFFORDINGIC COVERAGE
NAC
INSURER A: sentinel Iaaaraace Contpany Ltd.
111000
INSURED [au]workshop, Ilc
L
405 05 Linden St
INSURER B : 11201 rd me Cn etlhe ula.est
137478
INSURER C:: XLSpeal.ay kueranee Comp.,ry
137885
Fort Collins, CO 80524
INSURER D :
INSURER E :
INSURER F
COVERAGES CERTIFICATE NUMBER: 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.
LTR
TYPE OF INSURANCE
IANDSR
y yap
POLICY NUMBER
MWDD EFF
MP�p E%P.
LIMITS
A
X( I COMMERCIAL GENERAL LIABILITY
Y
Y
34SBWPP2901
1/01/2019
11/01/2020
EACH OCCURRENCE
$1000000
CLAIMS -MADE OCCUR
PR EMISES Eaocarrence
$1 000000
MED EXP (Any one person)
$10 000
PERSONAL &ADV INJURY
$1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY JECO 7 ^I T ❑ LOC
GENERAL AGGREGATE
s2,000,000
PRODUCTS -COMP/OPAGG
$Z OOO 000
$
OTHER:
A
AUTOMOBILE LIABILITY
Y
Y
34SBWPP2901
11l01/20191.1/MANZ
- -
COMBINED SINGLE LIMIT
Eaauwidam
-
1,000,000
BODILY INJURY (Per person)
$
ANY AUTO
OWNED. SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
IX AUTOS ONLY %( AUTOS ONLY
BODILY INJURY(Per accident)
$
PROPERTY DAMAGE
Per. accitlent
$
$
A
�UMBRELLA
LIAB
X
OCCUR
Y
Y
34SBWPP2901
1/01/2019
11/01/2020
EACHOCCURRENCE
$1000000
AGGREGATE
$1000000
EXCESS LIAB
CLAIMS -MADE
DED I X I RETENTION $1 O 000
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Y / H
OFFICER/MEMBER EXCLUDED? �
(Mandatory In NH)
N/A
y
34WECAA0595
3/08/2019
- ..- - ..
03/08/202
- .
X. PER OTH-
TuTE ER
E.L. EACH ACCIDENT
$�000
E.L. DISEASE -. EA EMPLOYEE
$100000
It yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE -POLICY LIMB
1 $500,000
C
Professional
DPR9940442
/naloi.9
04/12/202
$1,000,000 perclaim
Liability
$2,000,000 annl aggr.
Claims Made
DESCRIPnON OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, nisy be aaaMed U more space 19 required)
As required by written contract or written agreement, the following provisions apply subject to the policy
terms, conditions, limitations and exclusions: The Certificate Holder and owner are included as Automatic
Additional Insured's for ongoing and completed operations under General Liability; Designated Insured under
Automobile Liability; and Additional Insureds under Umbrella / Excess Liability but only with respect to
liability arising out of the Named Insured work performed on behalf of the certificate holder and owner.
(See Attached Descriptions)
City of Fort Collins
300 Laporte Ave
Fort Collins, CO $0524
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE: THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE. POLICY PROVISIONS.
ACORD25 (2016/03) 1 of 2
#S27101000/M27100126
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