HomeMy WebLinkAbout565922 AU WORKSHOP LLC - INSURANCE CERTIFICATE (5)Client#: 1090169
ALIWORLLC
ACCORD. CERTIFICATE OF LIABILITY INSURANCE
DATE(MMDNYYY)
11/08/2019
THIS CERTIFICATE ISIISSUED"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 OFtNSURANCE 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(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).
PRODUCER
CUNT ACT- -"- - - --
NAME:
USI Insurance Services, LLC
PHONEI FAX
Elti:g00 873 8500
P.O. Box 7050
E-MAIL
Englewood, CO 80155
ADDRESS:
800 873-8500
INSURER(S) AFFORDING COVERAGE
I NAIC x
INSURER A : Santhel I^aurenca Company Lai.
111000
INSURED [au]Workshop, Ilc
INSURER B :. ROWerd Ins Co of the 111"Vat
37478
405 Linden St
INSURER C : XL Speeishy Insurance Company
37885
Fort Collins, CO 80524
INSURER D :INSURER
E:
INSURER F:
COVERAGES CERTIFICATF NIIMRFR- 129VI4l61M AtilaAovo•
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEENISSUEDTO 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. -
INSR
LTR
TYPE OF INSURANCE
ADDL
INSR
SUBR
WVD
POLICY NUMBER
POLLI1CY EFF
MM/DD/1NY
POLICY EXP
MM/DD/YYYY
LIMITS
A
)(
I COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE � OCCUR
Y
Y
34SBWPP2901
1/01/2019
11/01/202C
EACH OCCURRENCE
$1 OOOOOO
PREMISES Ea oaTurte"nce
$1 OOO OOO
MED EXP (Any one person)
$1 O 000
PERSONAL B ADV INJURY
$1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY O JEOT I__I LOC
OTHER:
GENERAL AGGREGATE
s2,000,000
PRODUCTS-..COMP/OP AGG
$2,000,000
$
A
AUTOMOBILE
LIABILITY
Y
Y
34SBWPP2901
-1/01/201.9
11/01'/202
COMBINED SINGLE LIMIT
Ea accident
1r000,000
BODILY INJURY (Per person)
$
ANY AUTO
AUTOS ONLY SCHEDULED
AUTOS
ONLY ONLY
NONOOWNEDHIREDUS AL
BODILY INJURY (Per accident)
$
X
PROPERTYDAMAGE
Per amid ent
$
$
A
)(I
UMBRELLA UAB
J(
OCCUR
Y
Y
34SBWPP2901
1110112019
1110112020
EACH. OCCURRENCE
$1000000
AGGREGATE
$1 OOO OOO
EXCESS LIAB
CLAIMS -MADE
DED X RETENTION $1O 000
$
B
WORKERS COMPENSATION
AND EMPLOYERS' UABILRY Y / N
ANY PROBRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? FYI
N/A
Y
34WECAA0595
3/08/2019
-
03/08/2020
-
X PER OTH-
TATUTE
E.L. EACH ACCIDENT
$1 OO OOO
E.L. DISEASE - EA EMPLOYEE
$1 OO OOO
(Mandatory In NN)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L DISEASE - POLICY LIMIT
$500 000
C
Professional
DPR9940442
4/12/2019
04/12/202
$1,000,000 per claim
Liability
$2,000,000 an it aggr;
Claims Made
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is 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
PO Box 580
Fort Collins, CO 80522-0580
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
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