HomeMy WebLinkAbout435885 NABI - 551382 NEW FLYER OF AMERICA INC - CONTRACT - AGREEMENT MISC - GR MAROLT & ASSOCIATES LLCACOR De CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDIYYYY)
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05/12/2015
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 tenns 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 ~2a~~cTRick Emerson Jr.
Rick Emerson Jr. Agent fA~?~n l'vfl· 303-7 81-1133 I r:i~ Nol: 303-862-4569
State f arm 4800 Happy Canyon Road Ste 230 it1D~~ss: rick@rickemersonjr.com
rl!!ffJ Denver, CO 80237 INSURER($) AFFORDING COVERAGE NAIC # ..
INSURER A ,State Farm Fire and Casualty Company 25143
INSURED GR Marolt & Associates LLC INSURER B :
3494 S Otis Ct INSURER C:
Lakewood, CO 80227-5331 INSURERD :
INSURERE :
INSURER F:
COVERAGES CERTIFICATE NUMBER: 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. NOTWlTHSTANDING 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
POLICY EFF POLICY EXP LIMITS
LTR IN~D wun POLICY NUMBER IMMIDOIYYYYl IMMIDDIYYYYI
A ~MMERCIAL GENERAL LIABILITY x EACH OCCURRENCE s 2,000,000
~ '"'"'"""" IBJ 0000'
U "Ml\\>C: I 0 '" '" I c:u $
PREMISES IEa occurrence\
96-BS-L 168-4 04/08/2015 O<l/08/2016 MED EXP
(Any one person) $ 5,000
PERSONAL & ADV INJURY $
R · GEN'L POLICY AGGREGATE D PRO- JECT llMrT APPLIES D LOC PER: GENERAL PRODUCTS AGGREGATE - COMP/OP AGG s $ 4,000,000
OTHER: $
A § OMO...,"""'"' x C_OMBINED SINGLE LIMIT s
IEa accidenll
ANY AUTO 289 4417-A28-06 01/28/2015 07/28/2015
BODILY INJURY {Per person) $ 1,000,000
ALL OWNED X SCHEDULED BODILY INJURY {Per accident) $ 1,000,000
AUTOS ~ ~~~~JWNEO PROPERTY DAMAGE
HIRED AUTOS AUTOS I Per accidenn $ 1,000,000
,._......
$
A x UMBRELL.A LIAB M OCCUR x 96-BS-1766-3 0410812015 04108/2016 EACH OCCURRENCE $
- 1,000,000
EXCESS LIAB CLAIMS·MADE AGGREGATE $
. DEO I I RETENTION $ $
WORKERS COMPENSATION I PER I I {,JIH·
AND EMPLOYERS' LIABILITY STATUTE ER
Y/N
ANY PROPRIETORIPARTNERIEXECUTIVE D NIA E.L. EACH ACCIDENT s
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH) E.L DISEASE - EA EMPLOYEE $
11 yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addlltonal Remarks Schedule, may be 1tt1che<1 If rnore space ls required)
CERTIFICATE HOLDER IS ADDITIONAL INSURED AS RESPECTS AUTO LIABILITY AND GENERAL LIABILITY.
CERTIFICATE HOLDER
CITY OF FORT COLLINS
P.O. BOX 580
FORT COLLINS, CO 80522
ACORD 25 (2014101)
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.
The ACORD name and logo are registered marks of ACORD
~··~·-··,~ATION . All rights reserved.
1001486 132849.9 02-04-2014