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HomeMy WebLinkAboutCOLORADO STATE UNIVERSITY OFFICE OF RISK MANAGEMEN - INSURANCE CERTIFICATE (4)P52("i28ix12 DATE (MM/DDIYYYY) A►C L)K" CERTIFICATE OF LIABILITY INSURANCE 07/13/2015 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 1-303-534-4567 CONTACT NAME_: IMA, Inc. - Colorado Division PHONE 1FAX UU-C HIT - -_--- 1705 17th Street E-MAIL ADDRESS: denaccounttechst?imacorp.com AFFORDING COVERAGE Suite 100 WYC0 _INSURERIS)_ INSURER A: LEXINGTON INS CO 19437 Denver, CO 80202 _ INSURERS: LEXINGTON INS CO (Risk Specialists CO.) 19437 INSURED Colorado State University INSURER CTRAVELER$ PROP CAS CO OF AVER 25674 Office of Risk Management & Insurance 141 Gen•l Sery Bldg -Campus Del 6002 INSURER0: SAFETY NATL CAS CORP 15105 INSURERE: UtIDERWRITERS AT LLOYDS 15792 Fort Collins, CO 80523-6021 INSURERF: C0VFRAGFS CERTIFICATE NUMBER: 44542860 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDDNYYY MMIDDIYYYY A X COMMERCIAL GENERAL LIABILITY 019210502 07/01/15 07/01/16 EACH OCCURRENCE $ 10,000,000 CLAIMS -MADE I X I OCCUR $ INCLUDED GETO RENTED PREMISES Ea occurrencei X MED EXP (Any one person) $ EXCLUDED SIR: $500, 000 PERSONAL & ADV INJURY $ INCLUDED GENERAL AGGREGATE $ 10, 000, 000 GENT AGGREGATE LIMIT APPLIES PER: POLICY D JECT LOC PRODUCTS - COMP/OP AGG $ INCLUDED $ OTHER: B AUTOMOBILE LIABILITY 019210502 07/01/15 07/01/16 COMBINED SIN LE LIMIT Ea accident S 10,000,000 BODILY INJURY (Per person) $ X ANY AU TO ALL OWNED SCHEDULED EDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE p accident X NC HIRED AUTOS X AUTOS $ _.. - g SIR:$500,0 0 $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ _ AGGREGATE EXCESS LAB CLAIMS -MADE $ DIED RETENTION $ $ C D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERlMEMBER EXCLUDED? (Mandatory in NH) NIA YOUB6070N92ATIL15-AO$ SP4053214 - CO ONLY 07/01/15 08/01/15 07/01/16 08/01/16 Z STEARTUTE I I OERTHYIN _- $ 1,000,000 --- "- $ 1,000,000 E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below $ 1,000,000 E.L. DISEASE - POLICY LIMIT WORKERS COMPENSATION AND SP4053214 -CO ONLY* EMPLOYERS' LIP.B_ILITY -Retention: ,500,000 (AOS=All Other States) DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Institute for the Built Environment (IBE) contract requirement. City of Fort Collins is included as Additional Insured on the General and Automobile Liability Policies if required by written contract or agreement subject to the policy terms and conditions. City of Fort Collins Purchasing ? Gerry S Paul PO Box 580 Fort Collins, CO 80522 l,AN%,CLLA I IUIV 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 zw USA � ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD kbulliung 44542860 K O 10 00 z L] P52NW2WM)2 SUPPLEMENT TO CERTIFICATE OF INSURANCE DATE 07/13/2015 NAME OF INSURED: Colorado State university Office of Risk Management 4 Insurance Additional Description of Operations/Remarks from Page 1: Additional Information: A4E Professional Liability Coverage: Policy #B0621PCOL0000115 Effective: 07/01/15-07/01/16 Insurer E: See Above $1,000,000 Per Claim Limit; $1,000,000 Aggregate Limit; $10,000 Deductible SUPP (05/04)