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HomeMy WebLinkAboutFOOTHILLS GATEWAY INC - INSURANCE CERTIFICATE (8)A``R �® CERTIFICATE OF LIABILITY INSURANCE 6/E(.WDD 5Y) 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 Flood and Peterson PO Box 578 Greeley CO 80632 CONTACT Kell Beauvais, CIC, CISR NAME: y PHONE xtI,(970) 356-0123 FA N C. : (970)330-1867 AoAIL .kbeauvaisQfloodpeterson.com INSURERS AFFORDING COVERAGE NAIC R INSURERA:Phl - Philadelphia Insurance INSURED Foothills Gateway, Inc. 301 West Skyway Drive Fort Collins CO 80525 INSURERB:Pinnacol Assurance 41190 INSURER C: INSURERD: INSURER E : INSURERF: COVERAGES CERTIFICATE NUMBER:CL1562904012 REVISION NUMBER: 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 ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTE PREMISES Ea ccurence $ 100,000 A CLAIMS -MADE 7X1 OCCUR PHPK1185640 /1/2015 /1/2016 MED EXP (Any one person) S 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER'. PRODUCTS - COMP/OP AGG $ 3,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1 000 000 X BODILY INJURY (Per person) S A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS PHPK1185640 /1/2015 /1/2016 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS Uninsured motorist combined $ 1,000,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 HCLAIMS-MADE AGGREGATE $ 2,000,000 A EXCESS LIAB DED I X I RETENTION$ 10,000 $ RUB461788 /1/2015 /1/2016 B WORKERS COMPENSATION WC STATU- OTH- , FR AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N/A 703552 /1/2015 /1/2016 E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 A Cyber Liability PHSD921871 /1/2015 /1/2016 $1,000,000 Ded $10, 000 Privacy Liability DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: 7th Annual Flying Pig 5K - April 12, 2015 The City of Fort Collins, its officers, agents, employees and volunteers are additionally insured as it relates to the 7th Annual Flying Pig 5K, which will be held on April 12, 2015. CERTIFICATE HOLDER CANCELLATION 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 Fort Collins - Risk Management PO Box 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522-0000 R Beauvais, CIC, CISR ACORD 25 (2010/05) INS025 (201005).01 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ADDITIONAL COVERAGES Ref # Description Abuse and Molestation Exclusion Coverage Code XABUM Form No. Edition Date Limit 1 1,000,000 Limit 2 1,000,000 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Professional Liability Coverage Code PROF Form No. Edition Date Limit 1 1,000,000 t 2 73,0,000 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium rOFADTLCV Copyright 2001, AMS Services, Inc.