HomeMy WebLinkAbout174626 FORT COLLINS HABITAT FOR HUMANITY - INSURANCE CERTIFICATE (6)DATE
CERTIFICATE OF LIABILITY INSURANCE (MM/03l02/207DD21201
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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 INSURERS(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
XWACT
Lockton Affinity, LLC
P.O. Box 873401
HONE
AIC No.Ext): 888-553-9002
Ax
JAJC, No):
DDRESS:
Kansas City, MO 64187-3401E-MAIL
INSURER(S) AFFORDING COVERAGE
NAIC
NSURER-A: ACE American Insurance Co.
22667
INSURED
NSURER-B:
Fort Collins Habitat for Humanity
4001 S Taft Hill Rd,
Fort Collins, CO 80526-2948
NSURER-C:
NSURER-
E,
NSURER-E:
NSURER-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 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.
IN
SR
LT
R
TYPE OF INSURANCE
ADDL
INSR
SUB
R
MID
POLICY NUMBER
POLICY EFF
MM/DD/YYYY)
POLICY EXP
MM/DD/YYYY)
LIMITS
A
GENERAL LIABILITY
OMMERCIAL GENERAL LIABILITY
LAIMS MADE X OCCUR
X
GL1064502-16
04/01/2016
04/01/2017
EACH OCCURRENCE
$ 1,000,000
Ii
DAMAGE TO RENTED
PREMISES Ea occurrence
$ 1,000,000
MED EXP An oneperson)
$ 0
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
EN'L AGGREGATE LIMIT APPLIES PER.
X OLICY
PRODUCTS — COMP/OP AGG
$ 2,000,000
$
AUTOMOBILE LIABILITY
NY AUTO
(ALL OWNED SCHEDULED
AUTOS
NON -OWNED
HIRED AUTOS AUTOS
COMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY Per Person
_
$
BODILY INJURY Per accident
$
--AUTOS
PROPERTY DAMAGE
Per accident
$
UMBRELLA LIAB
XCESS LAB
OCCUR
CLAIMS MADE
EACH OCCURRENCE
$
AGGREGATE
$
ED I I RETENTION $
ORKERS COMPENSATION
ND EMPLOYERS' LIABILITY
%NY PROPRIETOR/PARTNER/EXECUTIVE Y/N
C STATU-
DRY LIMITS
TH-
R
FFICER/MEMBER EXCLUDED?
_
E.L. EACH ACCIDENT
$
MANDATORY IN NH)
f yes, describe under
E.L. DISEASE — EA EMPLOYEE
$
ESCRIPTION OF OPERATIONS below
E.L. DISEASE —POLICY LIMIT
$
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
I AUTHORIZED REPRESENTATIVE I
City of Fort Collins
P.O. Box 580,
Fort Collins, CO 80522
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
1064502