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HomeMy WebLinkAbout501149 FORT COLLINS MUSEUM OF DISCOVERY - INSURANCE CERTIFICATE (2)FCMUS-1 OP ID: DA ACORD° r ATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE TE(MM/ DIYY 015 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 endorsement(s). PRODUCER CONTACT NAME: Diana Vigil Brown & Brown Inc PHONE FAX 4532 Boardwalk Dr, Suite 200(A/C, A/c No Ell: 970-482-7747 (A/C, No): 970-484-4165 E MAIL Fort Collins, CO 80525 ADDRESS: dvigil@bbcolorado.com Karen E. Siwek, CPA _ INSURER A: Philadelphia Indemnity Ins Co 18058 INSURED Fort Collins Museum of INSURERS:Pinnacol Assurance Company 41190 Discovery INSURERC: 408 Mason Ct Ft Collins, CO 80524 INSURER0: INSURER E : INSURER F : Cr)VFRAnFS CFRTIFICATF NIIMRFR REVISION NLIMRER- 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. INSIR TYPE OF INSURANCE AD L SUER POLICY NUMBER MM/ D/YYYY MM/DD/YY P LIMITS LTR A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X PHPK1305875 04/29/2016 04/29/2016 EACH OCCURRENCE $ 1,000,00 -DAMAGE RENTED PREMISES Ea occurrence $ 1,000,00 MED EXP (Any one person) $ 20,00 PERSONAL & ADV INJURY $ 1,000,00 GENT AGGREGATE LIMIT APPLIES PER: POLICY PRO JECT [] LOC OTHER: GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP/OP AGG $ 2,000,00 Emp Ben. $ 1,000,00 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X X NON -OWNED HIRED AUTOS AUTOS PHPK1305875 04/29/2016 04/29/2016 COMBINED SINGLE LIMIT Ea accident $ 1,000,00 $ $ $ BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident A X UMBRELLA LIAB EXCESS LIAB JC OCCUR CLAIMS -MADE PHUB492662 04/29/2015 04/29/2016 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 DED I X RETENTION $ 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 2310302 05/01/2015 05/01/2016 XPER STATUTE ER H E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEE $ 600,00 500 OO $ , E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is listed as Additional Insured per form PIGLDMK 03/12 GtK I Ill -ILA I C MULUCK \+Hrv�.CLLH 1 IVry FTCOLLI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ft. Collins Risk Management Department 215 N. Mason AUTHORIZED REPRESENTATIVES / Fort Collins, CO 80522 AAA V ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD