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HomeMy WebLinkAbout113275 ALM2S - INSURANCE CERTIFICATE (4)ACC) V CERTIFICATE OF LIABILITY INSURANCE DATE jM't/202YYY) 03/26/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFlRMATNELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE &'INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT. B 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 comil rights to the certificate. holder inlieu of such endorsement(s). PRODUCER Brown & Brown of Colorado, Inc. 4532 Boardwalk Dr., Suite 200 Fort Collins CO 80525 _NAME: AltBVillarreal PHONE (970) 482-7747 (970) 484-4165 No AO AID AIL certificates@bboolorado.com INSURER(S) AFFORDING COVERAGE NAIC 0 INSURERA: Westfield Insurance Company - 24112 _ INSURED alm2s 712 Whalers Way, Ste. B-100 Fort Collins CO 80525 INSURERS: Pinnacol Assurance _- 41190 INSURER C : Everest Nationallnsurance Company 10120 INSURER D: INSURER E : INSURER F : CnVFRArFS CERTIFICATE NUMBER- 20.21 Master REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THEINSURED 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 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. ILm TYPE OF INSURANCE POLICY NUMBER MMID EFF MMID LIMBS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00.0 CLAIMS -MADE Fx-1 OCCUR PREMISES(Ea occuvenm . s_ 1001-000 MEDEXP (Any aria on s 5,000 EPL-$100,000Aggregate A Y BOP3719966 04/01/2020 04/01/2021 PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ 2,000,000 PRODUCTS -COMPIOPAGG $ 2,000,000 POLICY JECT El LOC Employee Benefits $ 1,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT -- - Es accident) $ 1,000,000 BODILY INJURY (Per Person) $ ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY BOP3719966 04/01/2020 04/01/2021 BODILY INJURY(Per accident) $ PROPERTY DAMAGE Per amdenl $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 _ A ExCESS LWB CLAIMS -MADE BOP3719966 04/01/2020 04/01/2021 DED I X1 RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROP.RIETORIFARTNERIEXECUTIVE OFFICERIMEMBEREXCLUDED4 N (Mandatory In NH) NIA 1951272 04/01/2020 04/01/2021 .STATUTE ERH- E.LEACHACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 - E.L. DISEASE - POLICY LIMIT I $ 1,000,000 If yes, desaibe under DESCRIPTION OF OPERATIONS Below C - — _ - --- --- - -_. Professional Liability - - - PL5E000679-201 -- 0001I2020 - - 04/0112021 Aggregate Limit — Each Claim Limit — $2,000;000-..- -- $2,000,000 Deductible $10,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addhlonal Remarks Schedule, may be Ntached S more apace Is required) The City of Fort Collins is named additional insured with regards to general liability. rentlelrax-unl nCO rAMrFI I ATInId SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE. DELIVERED IN City of Fort Collins Purchasing Division ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 AUTHORIZED REPRESENTATIVE Fort Collins CO 80522� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016108) The ACORD name and logo are registered marks of ACORD ACOR& 114/ AGENCY CUSTOMER ID: 06311726 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of AGENCY Brown & Brown of Colorado, Inc. NAMED INSURED alm2s POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance: Notes When required by written contract the following applies: Blanket Additional Insured BP 0451 Primary and Non -Contributory BP 1488 Blanket Waiver of Subrogation BP 0497 Additional Insured - State. or Governmental Agency or Subdivision or Political Subdivision = Permits orAuthorization Relating to Premises BP 0407 Blanket Additional Insured -Owners Lessees or Contractors with Additional Insured Requirements for Parties in Construction Contract SIP 0451 Automobile - Blanket Additional Insured CA 7078 Blanket Waiver of Subrogation CA,0444 Umbrella - Following Form Workers Compensation - Blanket Waiver of Subrogation 359-B ACORD 101 (2008101) 0 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD