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HomeMy WebLinkAbout273449 PONDER COMPANY INC - INSURANCE CERTIFICATE (5)A� o® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDYYYY) 9/3/2015 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 DFB Insurance Group of Amarillo LLC 301 S. Polk St., Ste 600 P.O. BOX 2169 Amarillo TX 79105 CONTACT Kim Pitt NAME: PH NNo Ext: (806) 356-6000 AX N0: (806)356-0615 E-MAIL ADDRESS: kpitt@dfbinsurance.com INSURER(S) AFFORDING COVERAGE NAIC# INSURERA:Travelers Indemnity of America INSURED Ponder Company, Inc. 1545 W Tufts Ave, Unit B Englewood CO 80110 INSURERB:Travelers Indemnity Co. of CT INSURERC:Travelers Indemnity Company INSURER DArgonaut 19801 INSURER E: INSURERF: COVERAGES CERTIFICATE NUMBER:CL1582412601 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 rypE OF INSURANCE ADDL1SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD/VYYY X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE � OCCUR DAMAGE TO TED PREMISES Ea occurrence) $ 500,000 MED EXP(Any one person) $ 5,000 I-660-389X9772-TIA-15 8/31/2015 8/31/2016 PERSONAL B ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO - POLICY ECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 I$ OTHER I I I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident g 1,000,00 0 BODILY INJURY (Per person) $ B X ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS BA-3616C486-15-SEL 8/31/2015 8/31/2016 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident) $ NON -OWNED HIRED AUTOS AUTOS X UMBRELLA LIAR X OCCUR EACH OCCURRENCE Is 5,000,000 I AGGREGATE $ 5,000,000 C EXCESS LIAB CLAIMS -MADE DED I X I RETENTION$ 5,000 $ CUP-6212Y708-15-42 8/31/2015 8/31/2016 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE n X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 D OFFICER/MEMBER EXCLUDED? LJ (Mandatory in NH) N / A WC 928058253474 8/31/2015 8/31/2016 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Northside Aztlan Community Center - Rabbit Room Aerobics Floor The general liability and auto policies include blanket additional insured endorsements (attached) that provide additional insured status to the certificate holder only when there is a written contract between the Named Insured and the certificate holder that requires such status. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 580 ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE M Phillips/KIM ACORD 25 (2014/01) INS025 (201401) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD