HomeMy WebLinkAboutHAGEN COLBERT LLC - INSURANCE CERTIFICATEHAGEN-2 OP ID: WR
ACOR�" CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY)07/20/2015
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 Will Rich
Brown & Brown Inc NAME:
4532 Boardwalk Dr, Suite 200 AICNNo.
E:970-494-4660 PHOE FAX N, : 970-484-4165
xt
Fort Collins, CO 80525 E-MAIL wrich@bbcolorado.com
House Account ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC A
INSURER A: Berkley Regional Specialty Ins 31295
INSURED Hagen Colbert, LLC INSURERB:
5123 Snead Ct.
Fort Collins, CO 80525 1INSURERC:
INSURER D
INSURER F :
/1nVCDAnI7Q rFRTIFIr ATF NI IMRFR- RFVIRInN 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
LTR
TYPE OF INSURANCEADDL
I
SUER
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MMIDDIYYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE � X OCCUR
CGL 0075870
06/22/2015
06/22/2016
EACH OCCURRENCE
$ _ _ 1,000,000
$ 100,000
$
PREMISES Ea occurrence
MED EXP (Any one person)
PERSONAL & ADV INJURY
$ 1,000,00
GEN'L AGGREGATE LIMIT APPLIES PER:
❑ JPRO-
POLICY LOC
OTHER:
GENERAL AGGREGATE
$ 2,000,00
PRODUCTS - COMP/OP AGG
$ 2,000,00
$
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIRED AUTOS AUTOS
OMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DED RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑ N I A
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
STATUTE ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYE
_
$
E.L. DISEASE - POLICY LIMIT
§
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
!`EDTIEI!`ATE UnI nED rAAIrGI I ATWIN
CITYFI1
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
P O Box 5080
AUTHORIZED REPRESENTATIVE
Fort Collins, CO 80522
House Account
(0 19t$t$-LU14 AUL)KU (.;UKFYUKA I IUN. All rignts reserVea.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD