HomeMy WebLinkAbout408379 OMNI INSTITUTE - INSURANCE CERTIFICATE (2)® —DATE CERTIFICATE OF LIABILITY INSURANCE {MMIDDfYYYY)04/02/2020
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATEDOES 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).
Moody Insurance Agency, Inc.
8055 East Tufts Avenue
Suite 1000
Denver CO 80237
PHDneA/C No, E:t : Al(303) 824-6600 rnwG No):(303) 370-0118
EMAIL -]aura. shaipe@rnoodyins.com -
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A: Nova Casualty Company
INSURED
Omni Institute
899 Logan St Ste 600
INSURER B : Charity First Insurance Services, Inc
INSURER C: Plnnacol Assurance
41190
INSURER D :
IDenver CO 80203 I INSURER F:
CnVERArEA CERTIFICATE NIIMRER• 20-21 Master RFVISION NIIMRFR-
THIS IS TO CERTIFY THATTHE 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. -
INSR
LTR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
POLICY EFF
MMIOD _.
POLICY EXP.
MMIDD
LIMITS
X
COMMERCIALGENERALLIABILITY
,EACH OCCURRENCE.
$ 1,000,000
CLAIMS -MADE � OCCUR
DAMAGE100,000
ce
PREMISES Ea occurren-
.S_-
_MEDEXP_(Any one person)
$ 15,000
PERSONAL&ADV.INJURY
$ Excluded
A
Y
CF1ML1000076102
04/01/2020
04/01/2021
GEN'LAGGREGATE LIMITAPPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
X POLICY ❑ PRO-
JECT LOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
OTHER:
AUTOMOBILE LIABILITY
-COMBINED SINGLE' LIMIT -
Ea accident
§ 1,000,000
BODILY INJURY (Per person)
$
ANY AUTO
A
OWNED SCHEDULED
AUTOS ONLY AUTOS
CFlML1000076102
04/01/2020
-
04/01/2021
BODILY INJURY (Per accident)
S
PROPERTY DAMAGE
Per. accident
$
X HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
H
$
X
UMBRELLA UAB
OCCUR
.EACH OCCURRENCE
$ 1,000,000
11
AGGREGATE
$ 1,000,000
B
I EXCESS LIAB
CLAIMS -MADE
CFIUM1000069100
04/01/2020
04/01/2021
DEC) I X RETENTION $ 10,000
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYR/PARTNERIEXECUTIVE
oFFICERIMEMBCER/MEMeER EXCLUDED? �
(Mandatory in NH)
NIA
4138550
04/01/2020
04/01/2021
STATUTE EERH
E.L. EACHACCIDENT
100,000
$ -
E.L. DISEASE - EA EMPLOYEE
$ 100,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE -POLICY LIMIT
500000 -
$ ,
Each Incident
$1,000,000
A
Social Service Professional Liability
CFlML1600076102
04/01/2020
04/01/2021
Aggregate Limit
$1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If mom space Is required)
See additional pages for additional coverage information.
r CDTIMi ATC Unl r1CD rANrEI I ATInM
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
'
THE EXPIRATION DATE THEREOF, NOTICE. WILL BE DELIVERED IN
City of Fort Collins Attn: Purchasing Dept
ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box.580
- -- - - -
AUTHORIZED REPRESENTATIVE
Fort Collins CO 80522
KW4 �
u lUtIO ZUTo AwrcU Luce-Urwl lUn. Au rlgms reserveo.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD