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Home My WebLink About560059 JAY DEE INC - INSURANCE CERTIFICATEJAYDEE1 OP ID: TA ,acoRO" CERTIFICATE OF LIABILITY INSURANCE DATE (MYYY) 11 /10/10/15 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). CONTACT PRODUCER Phone: 301-417-0001 NAME: Tammy Amoriell Moody & Associates, Inc. Fax: 301 417-0040 PHONE FAX - 20251 Century Blvd, Suite 425 HONE No Ext : A/C No): Germantown, MD 20874-1191 E-MAIL Moody & Associates, Inc. ADDRESS: Tamoriell@moodyinsurance.com INSURED Inc. Via Jay Dee Inc. 7080 W.16th Avenue Lakewood, CO 80214 INSURER(S) AFFORDING COVERAGE NAIC_ # INSURER A: Sentinel Insurance Co Ltd 11000 INSURER B: Hartford Accid 8t Indemnity Co 22357 INSURER C : Nautilus Insurance Company 17370 F: COVERAGES CERTIFICATE NLIMRFR- RFVIRInN NI IMRFR- 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. I�TRR TYPE OF INSURANCE �D POLICY NUMBER MM/DDPOLICY/YYYY MM/DDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 1,000,0 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE L� OCCUR X 42SBARU2275 01/01/15 01/01/16 MED EXP (Any one person) $ 10,00 PERSONAL BADVINJURY $ 1,000,0 X Extd Property Dam GENERAL AGGREGATE $ 2,000,0 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPlOP AGG $ 2,000,00 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINEDSINGLE LIMIT acdtlent $ 1,000,000 BODILY INJURY (Per person) $ B X ANY AUTO X 42UECNA1340 01/01/15 01/01/16 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) ) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 2,000,00 AGGREGATE $ 2,000,000 A EXCESS LIAB CLAIMS -MADE 42SBARU2275 01/01/15 01/01/16 DIED I X I RETENTION $ 10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? FN (Mandatoryin NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA A 42WECCS1332 01/01/15 01/01/16 X VUC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,00 E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Fidelity Bond 42SBARU2275 01/01/15 01/01/16 Limit 25,00 C Pollution Liabilit CIP20064103 01/01/15 01/01/16 Occ/Aggre 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Any person or organization is additional insured under General Liability if such status is required in a written contract or agreement as outlined in coverage form # SS0008 04/05. *Such coverage includes Products & Completed Operations coverage. Email: Mel Winden MWINDEN@fcgov.com CFRTIGI(-ATF writ nPP r`AKlr`CI I ATVVJ CITYF01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Collindale Golf Course - ACCORDANCE WITH THE POLICY PROVISIONS. CB & Potts AUTHORIZED REPRESENTATIVE 1441 East Horsetooth Road Fort Collins, CO 80525 U 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD