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HomeMy WebLinkAboutLIBERTY COMMON SCHOOL - INSURANCE CERTIFICATE (3)LIBER-8 OP ID: DA ACORN' CERTIFICATE OF LIABILITY INSURANCE 7TE;MMIDDIYYYY) 622/2015 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 NAME CT Diana Vigil Brown & Brown Inc PHONE - - FAX 4532 Boardwalk Dr, Suite 200 Alc No Ell: 970-482-7747 A/c No): 970-484-4165 Fort Collins, CO 80525 ADDRESS: dvigil@bbcolorado.com Karen E. Siwek, CPA INSURERS AFFORDING COVERAGE NAIC N INSURER A: Hartford Fire Insurance Co. 19682 INSURED Liberty Common School INSURER B: Pinnacol Assurance Company 41190 1725 Sharp Point Dr. INSURER C: Hartford Casualty Insurance Co 29424 Fort Collins, CO 80525 INSURER D:Owners Insurance Company 32700 INSURER E: Auto -Owners Insurance Co. 118988 INSURER F COVFRAGFS CERTIFICATE Nl1MRFR- RFVISInN NIIMRFR- 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 ADDL SUBRI POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE � OCCUR X 34UUNRA2958 07/01/2015 07/01/2016 DAMAGE(Eaa ooc EDcurrence PREMISESS c $ 30O� 0O X MED EXP (Any one person) $ 10,00 Educators Legal ClaimsMade PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY PRO C1 LOC JECT PRODUCTS - COMP/OP AGG $ 2,000,00 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1 ()I)0 00 BODILY INJURY (Per person) $ D X ANY AUTO 4900313201 07/01/2015 07/01/2016 ALL OWNED SCHEDULED AUTOS AUTOS $ BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 E EXCESS LIAB CLAIMS -MADE 4900313202 07/01/2016 07/01/2016 DED I X I RETENTION $ 10000 $ B WORKERS COMPENSATION EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N 4046263 07/01/2015 07/01/2016 X STATUTE STATUTE ER E.L. EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N / A E.L. DISEASE - EA EMPLOYEE $ 500,00 If yes, describe under DESCRIPIION OF OPERATIONS below $ 500'00 E.L. DISEASE -POLICY LIMIT E Bus Umbrella 4900313202 07/01/2015 07/01/2016 (Each 5,000,00 !Aggregate 5,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is included as an additional insured on the general liability policy per HIS 0001 0605 CITYF11 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. Risk Management P O Box 508 AUTHORIZED REPRESENTATIVE, / Fort Collins, CO 80522 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD LIBER-8 OP ID: DA ACORN 7TE(MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE /19/2015 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: Brown & Brown Inc PHONE FAX 4532 Boardwalk Dr, Suite 200 A/c No Ext : A/C No): Fort Collins, CO 80525 E-MAIL Karen E. Siwek, CPA ADDRESS: INSUREII AFFORDING COVERAGE NAIC # INSURER A: Hartford Fire Insurance Co. 19682 INSURED Liberty Common School INSURER B: Pinnacol Assurance Company 41190 Tim Ricketts INSURER C : Hartford Casualty Insurance Co 29424 1725 Sharp Point Dr. Fort Collins, CO 80525 INSURER D: Owners Insurance Company32700 INSURER E : INSURER F r nVFRARFC CFRTIFICATF NI IMRFR• RFVISION Nl1MRFR- 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. IPOLICY LT LTR R TYPE OF INSURANCE ADDL UBR POLICY NUMBER EFF MM! D/YYYY POLICY EXP MM DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X 34UUNRA2958 07/01/2014 07/01/2015 DAMAGEPREMISESS( RENTED Ea occurrence $ 300,00 CLAIMS -MADE FXI OCCUR MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 1,000,00 X Educators Legal Claims Made GENERAL AGGREGATE $ 2,000,0010 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00 $ POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,00 BODILY INJURY (Per person) $ D X ANY AUTO 4900313200 07/01/2014 07/01/2015 BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS PROPERTY DAMAGE PER ACCIDENT - $ NON -OWNED HIRED AUTOS AUTOS X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,00 AGGREGATE $ 10,000,00 C EXCESS LIAB CLAIMS -MADE 34RHURA2215 07/01/2014 07/01/2015 DED I X RETENTION $ 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) IN/ A I4046263 07/01/2014 07/01/2015 X WC STATU- OTH- T RY LIMIT R E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEE $ 500100 E.L. DISEASE - POLICY LIMIT 1 $ 500,00 If yes, describe under DESCRIPTION OF OPERATIONS below I NO COVERAGE DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder is included as an additional insured on the general liability policy per HG 0001 0605 CITYF11 City of Fort Collins t:ANI;tLLA I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Risk Management P O Box 508 AUTHORIZED REPRESENTATIVE, / Fort Collins, CO 80522 V t ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD