HomeMy WebLinkAboutPOUDRE SCHOOL DISTRICT R-1 - INSURANCE CERTIFICATECOLORADO SCHOOL DISTRICTS SELF INSURANCE POOL
CERTIFICATE OF COVERAGE
THIS CERTIFICATE IS ISSUED AS A MATTER
OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON
THE
07/01/2015
CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND
OR
ALTER THE COVERAGE AFFORDED BY THE
POLICY BELOW. THIS CERTIFICATE OF INSURANCE DOES
NOT
CONSTITUTE A CONTRACT BETWEEN THE
ISSUING INSURER, AUTHORIZED REPRESENTATIVE AND
THE
CERTIFICATE HOLDER.
MEMBER:
POUDRE SCHOOL DISTRICT R-1
ATTN:
Kristin Bennett
Colorado School Districts Self
ADDRESS:
2407 LA PORTE AVENUE
Insurance Pool
CITY, STATE ZIP:
FORT COLLINS, CO 80521 2297
6857 South Spruce St.
Centennial, Colorado 80112
POLICY NUMBER:
6216-15-00215
(303) 722-2600
POLICY PERIOD:
07/01/2015 to 07/01/2016
(303) 722-7888 Fax
THIS IS TO CERTIFY
THAT THE POLICY OF COVERAGE LISTED BELOW HAS
BEEN ISSUED TO THE MEMBER 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 COVERAGE AFFORDED
BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE
TERMS,
EXCLUSIONS, DEFINITIONS
AND CONDITIONS OF SAID POLICY. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF COVERAGE
LIMITS/DEDUCTIBLES
SCHOOL ENTITY LIABILITY
Occurrence Form
EACH OCCURRENCE OR WRONGFUL ACT
$5,000,000
ANNUAL AGGREGATE LIMIT
$10,000,000
MEDICAL EXPENSE (PER PERSON/PER ACCIDENT)
$1,000/$10,000
AUTOMOBILE
Any Auto, Hired and Non -Owned
LIMIT PER ACCIDENT
$5,000,000
Medical Payments
LIMIT PER ACCIDENT/PER PERSON
$5,000
PROPERTY
Special Form
BUILDING/BUSINESS PERSONAL PROPERTY LIMIT
$782,619,674
DEDUCTIBLE
$100,000
Auto Physical Damage Coverage
AUTO PHYSICAL DAMAGE DEDUCTIBLE
$10,000
PROPERTY DAMAGE TO PREMISES RENTED TO YOU
$500,000
DESCRIPTION OF OPERATIONS LOCATIONS VEHICLES SPECIAL ITEMS
Certificate Holder is included as an
Additional Insured on the Member's School Entity Liability Coverage
& Auto Liability
Coverage for "bodily injury", "personal
injury" or "property damage" caused by the Member's negligence
if required by
written contract or agreement subject
to the policy terms and conditions with respects to any function or
activity held on
the Certificate Holder's premises during the policy period.
CANCELLATION: SHOULD THE ABOVE DESCRIBED POLICY BE
CERTIFICATE HOLDER:
CANCELLED BEFORE THE EXPIRATION DATE,
WE WILL ENDEAVOR
TO MAIL 30 DAYS WRITTEN NOTICE TO THE
CERTIFICATE HOLDER
NAMED TO THE LEFT, BUT FAILURE TO MAIL
SUCH NOTICE SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY
KIND UPON THE
COMPANY, ITS AGENTS OR REPRESENTATIVES.
City of Fort Collins Risk Management Department
AUTHORIZED REPRESENTATIVE_
P 0 Box 580
Fort Collins, CO 80521