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HomeMy WebLinkAbout102831 LARIMER HUMANE SOCIETY DBA ANIMAL PROTECTIO - INSURANCE CERTIFICATE (3)------ S LARIHUM-01 DMCGEE ,d►CORO CERTIFICATE OF LIABILITY INSURANCE DATE (M �� 6/29/201YYY) 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 NAMEACT Debbie McGee TrueNorth PHONE FAX PO Box 847 WC,No Ext : (303) 776-5122 A/c No): (303) 776-5495 Longmont, CO 80502 AD E-MAIL dmcgee@truenorthcompanies.com INSURED Larimer Humane Society dba Larimer Animal Protection 8, Control 5137 South College Avenue Fort Collins, CO 80525 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Great American Assurance Company 26344 INSURER B : Great American Alliance Insurance Company 26832 INSURER C : Pinnacol Assurance Companv 41190 INSURER D : INSURER E : INSURER F : nnVFRAAFR CFRTIFIr.ATF IJI IMRFR• 0C1/IQrnW KII reeDCD. 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 TYPE OF INSURANCE LTR D L' POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE A , OCCUR PAC5373770 07/01/2015 07/01/2016 EACH OCCURRENCE $ 1,000,00 -DAMAGE TO RENTED PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 10,00 PERSONAL 8 ADV INJURY $ 11000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JERCOT- LOC OTHER GENERAL AGGREGATE $ 2,000,00 X PRODUCTS -COMP/OP AGG $ 2,000,00 VET PROFESSION $ 1,000,00 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS X AUTOS CAP5373771 07/01/2015 07/01/2016 ECOM aBINEDISINGLE LIMIT $ 1,000,00 $ $ X BODILY INJURY (Per person) BODILY INJURY Per accident ( ) X PROPERTY DAMAGE Paraccident $ _ B X UMBRELLA LIAR EXCESS PX OCCUR CLAIMS -MADE UMB5373772 07/01/2015 07/01/2016 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 $ DED I X I RETENTION $ 10,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED9 ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 4015370 07/01/2015 07/01/2016 PER OTH- STATUTE I ER E.L. EACH ACCIDENT $ 100,00 E.L. DISEASE -EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT 1 $ 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins as Additional Insured as Required by Written Contract Per Policy Form. �r=rt „r wry r r= nvL-ur=r% `I.AIV4CLLA I IVIV City of Fort Collins Purchasing Department P O Box 580 Fort 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 X4 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD LARIHUM-01 DMCGEE CERTIFICATE OF LIABILITY INSURANCE r ATD/YYYY) 6/29/229/2015 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 CONTACTNAME: Debbie McGee TrueNorth PHONE FAX PO Box 847 JVC (303) 776-5122 A/c No): (303) 776-5495 Lon mont, CO 80502 EMAIL /� g ADDRESS: dmcgee(M_truenorthcompanies.com INSURED Larimer Humane Society 5137 South College Avenue Fort Collins, CO 80525 INSURERS) AFFORDING COVERAGE NAIC # INSURER A: Great American Assurance Company 263" INSURER B : Great American Alliance Insurance Company 26832 INSURER C : Pinnacol Assurance Company 41190 INSURER D : INSURER E : INSURER F : C()VFRAf'FA CFRTIFIrATF NI IRARFR• RFVICInN wl I1001=0- 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 L UB POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR I PAC5373770 I 07/01/2015 07/01/2016 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 10,000 PGEN'L PERSONAL & ADV INJURY $ 1,000,00 X AGGREGATE LIMIT APPLIES PER: POLICY 7PRO- LOC OTHER: GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP/OP AGG $ 2,000,00 VET PROFESSION $ 1,000,00 AUTOMOBILE LIABILITY A X ANY AUTO ALL OWNED SCHEDULED I AUTOS AUTOS X HIRED AUTOS NON -OWNED X AUTOS CAP5373771 07/01/2015 07/01/2016 Ea aBINED SINGLE LIMIT $ 1,000,000 $ $ _ $ BODILY INJURY (Per person) BODILY INJURY Per accident ( ) PROPERTY DAMAGE Per accident B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE UMB5373772 07/01/2016 07/01/2016 EACH OCCURRENCE $ 1,000,00 $ 1,000,00 $ AGGREGATE DED I X I RETENTION $ 10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N C ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 015370 07/01/2015 07/01/2016 PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 100,00 E.L. DISEASE - EA EMPLOYEE $ 100,00 E.L. DISEASE - POLICY LIMIT Is 500,00 i DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) "The City of Fort Collins, its officers, agents, employees and volunteers are additionally insureds regarding General Liability CERTIFICATE HOLDER CANCELLATION City of Fort Collins Risk Management P O Box 580 Fort 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 "00-1(4 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD