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HomeMy WebLinkAbout466500 COLORADO STATE UNIVERSITY - INSURANCE CERTIFICATE (2)�1 ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/rM) 12222Di5 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 ADD Risk services south, Inc. Franklin TN Office CONTACT NAME: PHONE aC NNo.Ext): (866) 283-7122 (� No : (800) 363-0105 E-MAIL ADDRESS: 501 Corporate Centre Drive Suite 300 Franklin TN 37067 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURERA: Lexington Insurance Company 19437 Colorado state Universitv INSURERB: The charter Oak Fire Insurance company 25615 1251 Mason Street Fort Collins CO 80523-6021 USA INSURERC: The Travelers Indemnity Co of CT 25682 INSURER D: INSURER E: INSURER F: lKIP4l AaICtWtl a;a1112 W1I Ia2P1tJ-1a MOTABIaF111:2115-I& 3a7FY 16121101/1 M:1 a: 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE INSD WV D POLICY NUMBER MM/DDa xP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY 07/01/2016 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X❑ OCCUR Excess GL SIR applies per policy terns & condl Jons DAMAGE TO RENTED PREMISES Ea occurrence MED EXP (Any one person) PERSONAL &ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $1,000,000 X POLICY ❑PEo- F—]LOC PRODUCTS - COMP/OP AGG OTHER: SIR/Deductible $ 500 , 000 C AUTOMOBILE LIABILITY BA-4279M262-15CAG 07/01/2015 07/01/2016 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY ( Per person) ANY AUTO BODILY INJURY (Per accident) ALL OWNED X SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE (Per accident A X UMBRELLA LIAB OCCUR 019210502 07/01/2015 07/01/2016 EACH OCCURRENCE $10,000,000 EXCESS LIAB H CLAIMS -MADE SIR applies per policy terns & condi ions AGGREGATE $10,000,000 DIED X RETENTION B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE N YOUB6070N92A15 07/01/2015 07/01/2016 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) ❑ N I A E.L. DISEASE -EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER 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. City of Fort Collins AUTHORIZED REPRESENTATIVE Attn: Lance Murray, Risk Manager Post Fort Office Collins Box 580 CO 80522-0580 USA ��/%• `iL�d�C �sutri�r0 c/ �v✓�sa ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD �1 ® CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYY) 2222016 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 Aon Risk services South, Inc. Franklin TN Office CONTACT NAME: A//cC.. No. Ext): (866) 283-7122 jac No): (800) 363-0105 E-MAIL ADDRESS: 501 Corporate Centre Drive suite 300 INSURER(S) AFFORDING COVERAGE NAIC # Franklin TN 37067 USA INSURED INSURER A: Lexington Insurance Company 19437 Colorado State Universitv INSURER B: The Charter Oak Fire Insurance Company 25615 1251 Mason Street Fort Collins CO 80523-6021 USA INSURERC: The Travelers Indemnity Co of CT 25682 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570060613742 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MWDDfYYYYI IMWDDNYYY)LIMITS A ERCUIL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 LAIMS-MADE ❑X OCCUR FC Excess GL SIR applies per policy terns & condl ions MA RENTED PREMISES Ea occurrence MED EXP (Any one person) PERSONAL B ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $1,000,000 X POLICY ❑!E0. �LOC PRODUCTS - COMP/OP AGG OTHER: SIR/Deductible $ 500 , 000 C AUTOMOBILE LIABILITY BA-4279M262-15CAG 07/01/2015 07/01/2016 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY ( Per person) ANY AUTO BODILY INJURY (Per accident) ALL OWNED X SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per accident A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 019210502 SIR applies per policy terns 07/01/2015 & COndi 07/01/2016 ions EACH OCCURRENCE $10,000,000 AGGREGATE $10,000,000 DED X RETENTION e WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE YOU86070N92A15 07/01/2015 07/01/2016 PER OTH- X STATUTE E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) ❑ N / A E.L. DISEASE -EA EMPLOYEE $1,000,000 o es, describe under D�SCRIFTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Sponsored Agreement IGA - CSU Oil and Air Quality Services. Certificate holder is included as Additional Insured in accordance with the policy provisions of the General Liability policy if required by written contract or agreement subject to the policy terms and conditions. CERTIFICATE HOLDER 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. City Of Fort Collins AUTHORIZED REPRESENTATIVE Attn: Ed Bonnette and Jerry Groves 215 N. Fort Mason Collins street 2nd Floor CO 80522 USA n/f c%��iGe�ri�0 O �ina 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ACORO ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMDD/YWY) 2 222015 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 AOn Risk services South, Inc. Franklin TN Office CONTACT NAME: C.. No. Ext): (B66) 283-7122 jac Na ): (800) 363-0105 E-MAIL ADDRESS: 501 Corporate Centre Drive Suite 300 INSURER(S) AFFORDING COVERAGE NAIC # Franklin TN 37067 USA INSURED INSURER A: Lexington Insurance Company 19437 Colorado State University INSURERB: The Charter Oak Fire Insurance Company 25615 1251 Mason Street Fort Collins c0 80523-6021 USA INSURERC: The Travelers Indemnity Co of CT 25682 INSURER D: INSURER E: INSURER F: COVERAGES . CERTIFICATE NUMBER: 57UUbUb13744 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY (MWDDrfYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS -MADE ❑X OCCUR Excess GL SIR applies per policy terns & condl ions DAMAGE PREMISES Ea occurrence MED EXP (Any one person) PERSONAL B ADV INJURY $1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $1,000,000 X POLICY ❑ PROJEC- LOC PRODUCTS - COMP/OP AGG OTHER: SIR/Deductible $ 500 , 000 C AUTOMOBILE LIABILITY BA-4279M262-15CAG 07/01/2015 07/01/2016 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY ( Per person) ANY AUTO BODILY INJURY (Per accident) ALL OWNED X SCHEDULED AUTOS AUTOS X HIREDAUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per accident A X UMBRELLA LIAB OCCUR 019210502 07/01/2015 07/01/2016 EACH OCCURRENCE $10,000,000 EXCESS LIAB HX CLAIMS -MADE SIR applies per policy terns & condi ions AGGREGATE $10,000,000 OED X RETENTION B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE Y❑ YOUB6070N92A15 07/01/2015 07/01/2016 X PER O STATUTE R E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) N / A E.L. DISEASE -EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below -.L. DISEASE -POLICY I ]MIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) City of Fort Collins is included as Additional Insured in accordance with the policy provisions of the General Liability and Auto Liability policies if required by written contract or agreement subject to the policy terms and conditions. CERTIFICATE HOLDER 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. City Of Ft Collins AUTHORIZED REPRESENTATIVE Attn: Purchasing - Gerry 5 Paul PO Box 580 Fort Collins CO 80522 USA 4 G J ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD