Loading...
HomeMy WebLinkAbout366358 JVA INC - INSURANCE CERTIFICATE (4)DATE (MM/ '`�� Rom® CERTIFICATE OF LIABILITY INSURANCE 5/1/2015 DDnrrr) 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 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 endorsements . PRODUCER CONTACT NAME: USI Colorado, LLC Prof Liab PHONE g00-873-8500 FAx P.O. Box 7050 c Ne art)• E-MAIL Enqlewood CO 80155 ADDRFSS- INSURERS AFFORDING COVERAGE NAIC # INSURERA:Charter Oak Fire Insurance Company 25615 INSURED JVAINC INSURERB:TravelerS Indemnity Company 25658 JVA, Inc. INSURERC:Pinnacol Assurance Company 41190 1319 Spruce Street Boulder CO 80302 INSURERD:XL Specialty Insurance Company 37885 Boulder INSURER E: Travelers Property Cas. Co. of Amer 25674 INSURER F : 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. INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS A X I COMMERCIAL GENERAL LIABILITY Y Y 68014211-860 /112015 5/1/2016 CLAIMS X EACH OCCURRENCE $1,000,000 DAMAGET RENTED -MADE OCCUR PREMISES Ea occurrence $1,000,000 MED EXP (Any one person) $10,000 PERSONAL BADVINJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: � PRO-- GENERAL AGGREGATE $2,000,000 - COMP/OP AGG $2,000,000 POLICY LOC JECTPRODUCTS OTHER: $ E AUTOMOBILE LIABILITY Y Y BA1696L578 /1/2015 /1/2016 B N SINGLE LIMIT Ea accident $ 1,000,000 ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS I%�X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE $ Per accident B X UMBRELLA LIAB X OCCUR Y Y 51112015 5/1/2016 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 EXCESS LIAB CLAIMS -MADE 76968Y20A DIEDX RETENTION S 10.000 $ C WORKERS COMPENSATION Y 4131403 /1/2015 5/1/2016 PER OTH- X AND EMPLOYERS' LIABILITY Y / N STATUTE ER E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYE $1,000,000 - _ (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS below $1,000,000 D Professional Liability Claims Made DPR9723645 /1/2015 5/1/2016 Per Claim 2,000,000 Aggregate 3,000,000 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 Insured's 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. The General Liability, Automobile Liability, Umbrella/Excess insurance applies on a primary and non-contributory basis. A Blanket Waiver of Subrogation applies for General Liability, Automobile Liability, Umbrella/Excess Liability and Workers Compensation. The Umbrella / Excess Liability policy See Attached... --' .... ' .'—" __" IiNIV�.CLLN I IVIV City of Fort Collins P.O. Box 580 Ft. Collins CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2014101) v 1988-ZU14 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ,acorra� AGENCY CUSTOMER ID: JVAINC LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY USI Colorado, LLC Prof Liab NAMED INSURED JVA, Inc. 1319 Spruce Street Boulder CO 80302 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 ,vides excess coverage over the General Liability, Automobile Liability and Employers Liability. rtificate Holder is included as an Additional Insured Ily for Project: 7666 Bobcat Ridge Historic Buildings Rehabilitation ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD