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495925 HAYS COMPANIES - INSURANCE CERTIFICATE (5)
AC C>R6r �. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 01/19/2016 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 1-612-333-3323 Hays Companies CONTACT NAME: Melody Rronbach or Ross Nerison PHONE 612-333-3323 FAX 612-373-7270 A/ No EAt : A/C No : 80 South Sth Street E-MAIL scorn mkronbach@ha anies.Com ADDRESS: Y P INSURERS AFFORDING COVERAGE NAIC# Suite 700 INSURER A:HARTFORD FIRE IN CO 19682 Minneapolis, MN 55402 INSURED INSURERB: SENTINEL INS CO LTD 11000 Hays Companies INSURERC: HARTFORD CAS INS CO 29424 INSURERD: 80 South 8th Street, Suite 700 INSURER E Minneapolis, MN 55402 INSURERF: UUVrKAhtJ CI-H I I1-IC01 F NI IMRFR• 45924155 DCVIClr%Kl A11111ADED• 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE U OCCUR 41UUNKW8239 01/19/16 01/19/17 EACH OCCURRENCE $ 1,000,000 DAMAGE To RENTED PREMISES Ea occurrence $ 1, 000, 000 MED EXP (Any one person) $ 10,000 - BADVINJURY $ 1,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC -PERSONAL GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY 41UUNKW8239 01/19/16 01/19/17 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) ANY AUTO $ ALL OWNED SCHEDULED AUTOS AUTOS $ BODILY INJURY Per accident ( ) HIRED AUTOS X NON -OWNED AUTOS $ X PROPERTY DAMAGE Per accident X COMP $1,00 X COLL $1,000 $ C X UMBRELLA LIAB X OCCUR 41XHUKW5423 01/19/16 01/19/17 EACH OCCURRENCE $ 25, 000, 000 AGGREGATE $ 25,000,000 EXCESS LIAB CLAIMS -MADE DED I X I RETENTION$ 10,000 $ '9' WORKERS MPENSATION AND EMPLOYORS'LABILIITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A 41WEBP7463 01/19/16 01/19/17 X STATUTE ERH E.L. EACH ACCIDENT $ 1, 000, 000 - E.L. DISEASE - EA EMPLOYE (Mandatory in NH) If Yes, describe under DESCRIPTION OF OPERATIONS below $ 1,000,000 $ 1,000,000 E.L. DISEASE - POLICY LIMIT I A Property 41UUNKW8239 01/19/16 01/19/17 Property 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) The City, its officers, agents and employees shall be named as additional insureds on the general liability and automobile liability policies, where required by writen contract. Ut:K I WIL,A I t HULUtK CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 I USA © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD RNerison A C00A1 CC