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HomeMy WebLinkAbout132158 CTL/THOMPSON INC - INSURANCE CERTIFICATE (26)CI ient#: 1082473 CTLTHO ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/01 /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 USI Colorado, LLC Prof Liab P.O. Box 7050 Englewood, CO 80155 800 873-8500 CAME:O AC N a"c°N E.Ext : 800 873-8500 A/C No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Charter Oak Fire Insurance Comp 25615 INSURED INSURER B : Travelers Indemnity Company 25658 /Thompson, Inc. INSURER C: Pinnacol Assurance Company 41190 730 6 S. Alton Way 30 INSURER D : Starr Surplus Lines Insurance C 13604 Centennial, CO 80112 INSURER E : 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. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMBS A X COMMERCIAL GENERAL LIABILITY X X 6802C991762 0/01 /2015 10/01/2016 OECCCURRENCE $1 000 000 CLAIMS -MADE 51OCCUR EEACH PREMISES Ea occurrence $11 0001 000 MED EXP (Any one person) $1 U 000 PERSONAL& ADV INJURY $19000000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X JECOT- 7 LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2,000 000 $ OTHER: A AUTOMOBILE LIABILITY X X 8101175R522 0/01/201510/01/201 EO, Nd SINGLE LIMIT am 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO X ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ B X UMBRELLA LIAB X OCCUR X X CUP3C002974 0/01/2015 10/01/2016 EACHOCCURRENCE $$000000 AGGREGATE s8,000,000 EXCESS LIAB CLAIMS -MADE DIED I X I RETENTION $10000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITYER ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? F N / A X 618052 10/01 /2015 10/01 /201 X PER OTH- E.L. EACH ACCIDENT $500000 E.L. DISEASE - EA EMPLOYEE $500 000 (Mandatory In NH) yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $500,000 D Professional SLSLPR026233615 10/01/2015 10/01/2016 _ $2,000,000 per claim Liability $4,000,000 annl aggr. Claims Made DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) As required by written contract or written agreement, the following provisions apply subject to the policy terms, conditions, limitations and exclusions: The Certificate Holder and owner are included as Automatic Additional Insured's for ongoing and completed operations under General Liability; Designated Insured under Automobile Liability; and Additional Insureds under Umbrella / Excess Liability but only with respect to liability arising out of the Named Insured work performed on behalf of the certificate holder and owner. (See Attached Descriptions) City of Fort Collins Purchasing Dept. PO Box 580 Fort Collins, CO 80522 UANGtLLAIIUN 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 ACORD 25 (2014/01) 1 Of 2 #S16364130/M16331562 ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AXGZP SAGITTA 25.3 (2014)01) 2 of 2 #S16364130/M16331562