HomeMy WebLinkAboutWANT ADS OF FORT COLLINS - INSURANCE CERTIFICATE (2)ACORU® CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYYYY)
8/29/2015
THIS CERTIFICATEIS 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 SUBROGATIONIS 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
PAYCHEX INSURANCE AGENCY INC
210705 P: F: (888) 443-6112
PO BOX 33015
SAN ANTONIO TX 78265
CONTACT
NAME
ac"N.,Ext):
FAX
.No): (888) 443-6112
ADDRIESS:
INSURER(S) AFFORDING COVERAGE NAIC#
wsURERA: Sentinel Ins Co LTD
INSURED
WANT ADS OF FORT COLLINS
1229 E MULBERRY ST
FORT COLLINS CO 80524
INSURERB: Hartford Fire Ins Co
INSURER C :
INSURER D:
INSURER E:
INSURER F:
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.
I1VSR
TYPE OF INSURANCE
ADD
POLICYNUMBER
POLICYEFF
POLICTE3&
LEW]fs
COMMERCIAL. GENERAL LIABILITYDAMAGE
EACH OCCURRENCE
$ ]., O Q 0 0 0 0
CLAIMS -MADE OCCUR
TO
PREMISES (Ea RENTED rrence)
$1 , 000, 000
A
General Liab
76 SBW RV6636
09/10/2015
09/10/2016
X
X
MED EXP (Any one person)
$10, 000
PERSONAL & ADV INJURY
$ 1 , 0 0 0, 0 0 0
GEN'L AGGREGATE LIMIT APPLIES PER
POLICY I PRO- ❑X Lac
JECT
GENERAL AGGREGATE
s2,000,000
PRODUCTS - COMPIOP AGG
s2, 000, 000
OTHER
AUTOMOBILE LIABILITY
A
COMBINED SINGLE LIMIT
(Ea accident)
$1 , 000, 000
BODILY INJURY (Per person)
ANY AUTO
X
BODILY INJURY (Per accident)
$
A
ALL OWNED SCHEDULED
AUTOS AUTOS
X HIRED AUTOS X NON -OWNED
AUTOS
76 SBW RV6636
09/10/2015
09/10/2016
PROPERTY DAMAGE
(Per accident)
$
$
UMBRELLA LIAR
EACH OCCURRENCE
$
EXCESS LUW
HOCCUR
CLAIMS -MADE
AGGREGATE
DE
RETENTION S
WOREF"COMPENSA72ON
ANDE fPL.OYERS'LLABLLYLY
ANY PROPRIETORIPARTNERIEXECUTIVEYIN
X PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
1100,000
B
OFFICERlMEMBER EXCLUDED?
(MaBdatoryinAIH) ❑
WA
76 WEG GH2394
09/26/2015
09/26/2016
E.LDISEASE- EAEMPLOYEE
I100, 000
If yes, describe under
E.L. DISEASE - POLICY LIMIT
$ rj 0 0 , 0 0 0
DESCRIPTION OF OPERATIONS below
DESCRF77ONOFOPERAT"VS/LOCATIONS/VEHICMRD 101, Additional Remarks Schedule, may be attached if more space is required)
Those usual to the Insured's Operations. Certificate Holder is an Additional
Insured per the Business Liability Coverage Form SS0008 attached to this
policy.
r`coTICtf`ATC uni nro t:ANUE!LLAI IUN
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 AUTHORQFD RFPRESENrATWE
PO BOX 588
FORT COLLINS, CO 80522
ACORD CORPORATION. All rights resery
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD