Loading...
HomeMy WebLinkAboutLIBERTY COMMON SCHOOL - INSURANCE CERTIFICATE (4)LIBER-8 OP ID: DA '4ca►Rv� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/22/2015 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: CONTACT Diana Vigil Brown &Brown IncPHOE 4532 Boardwalk Dr, Suite 200 A/CNNo, Ell: 970482-7747 FAX No): 970-484-4165 Fort Collins, CO 80525 A bDRESS: dvigil@bbcolorado.com Karen E. Siwek, CPA INSURERS AFFORDING COVERAGE NAIC # _ 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. 18988 INSURER F : COVERAGES CFRTIFICATF Nt1MRFR- RFVISInN NI IMRFR- 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 -- -- -- - ILTR TYPE OF INSURANCE INSD W - POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fj� OCCUR X 34UUNRA2958 07/01/2015 07/01/2016 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED PREMISES Ea occurrence $ 300,00 X MED EXP (Any one person) $ 10,00 Educators Legal ClaimsMade PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO JECT EI LOC GENERAL AGGREGATE $ 2,000,00 $ 2,000,00 PRODUCTS - COMP/OP AGG OTHER: $ AUTOMOBILE LIABILITY DtSINGLE LIMIT Ea accident) $ 1,000,00 X BODILY INJURY (Per person) D ANY AUTO 4900313201 07/01/2016 07/01/2016 $ AOSCHEDULED AUTOS AUTOS $ BODILY INJURY (Per accident) idt ) NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Peraccident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 AGGREGATE E EXCESS LIAB CLAIMS -MADE 4900313202 07/01/2015 07/01/2016 $ 5,000,00 DED X RETENTION $ 10000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY B ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes describe under ,DESCRIPTION OF OPERATIONS below NIA 4046263 07/01/2015 07/01/2016 X PER R STATUTE ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEE $ 500,00 $ 500,00 E.L. DISEASE - POLICY LIMIT E 'Bus Umbrella 4900313202 07/01/2015 07/01/2016 Each 5,000,00 Aggregate 51000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Liberty Common High School Torch Trek The City of Fort Collins, Its officers, agents, employees & volunteers are included as an additional insured if required by written contract per HG 0001 0605 CITYFOR 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 AUTHORIZED REPRESENTATIVE P.O. Box 580 Fort Collins, CO 80522-0580 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD