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Home My WebLink About501351 WORKSPACE INNOVATIONS LLC - INSURANCE CERTIFICATEAC40 o® CERTIFICATE OF LIABILITY INSURANCE Dg/28/2015 ) 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 endorsements). PRODUCER Moody Insurance Agency, Inc. 8055 East Tufts Avenue Suite 1000 Denver CO 80237 CONTACT Cathy Baker NAME: Y tPA NENo. Exti,(303)824-6600 FA No: (303)370-0118 E-MAIL ADDRESS: y Cath .baker@moodyins.com INSURERS AFFORDING COVERAGE NAICIf INSURERA:Union Insurance Co 25844 INSURED Workspace Innovations, LLC 4414 E. Harmony Road #100 Fort Collins CO 80528 INSURERB:Pinnacol Assurance 41190 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:15-16 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 POLICYNUMBER POLICY EFF MM/DD/YYYY POLICY EXP /Y MM/DDYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE1XI OCCUR X CPA 3070334-21 9/1/2015 9/1/2016 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- JECT LOC - OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000, 000 Employee Benefits $ 11000,000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUUTOSS AUTOS HIRED AUTOS NON - OWNED AUTOS X CPA 3070334-21 9/1/2015 9/1/2016 COMBINED SINGLE LIMIT Ea accident $ - 1,000,000 %� BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ Underinsured motorist $ Included A X UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE CPA 3070334-21 9/1/2015 9/1/2016 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 DED RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORrPARTNEWEXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 4129130 2/1/2015 2/1/2016 I STATUT ERH E.L. EACH ACCIDENT $ 1,000,000. E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) City of Fort Collins Attn: Jennifer Harvey P.O. Box 580 Fort Collins, CO 80522 VN 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 by Baker/CATBAK < ACORD 25 (2014/01) INS025 (201401) 01988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD