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HomeMy WebLinkAbout457580 J F SATO & ASSOCIATES INC - INSURANCE CERTIFICATE (11)Client#: 1084594 1F5 ACORD,. CERTIFICATE OF LIABILITY INSURANCE FEAIDD�YYYY) 1/14/ 1 /14/2016 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($). PRODUCER 'CONTACT NAME: USI Colorado, LLC Prof Liab PHONE Ext , 800 873-8500 aC No): P.O. Box 7050 E-MAIL Englewood, CO 80155 ADDRESS: --_-- INSURER(S) AFFORDING COVERAGE NAIC # 800 873-8500 INSURER A, Hartford Casualty Insurance Co 29424 INSURED INSURER B: XL Specialty Insurance Company,37885 J. F. Sato &Associates, Inc. --- 5878 So. Rapp Street INSURER C : Littleton, CO 80120 INSURERD: 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 POLICY EXP MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 34SBWPP2160 1 /31 /2016 01/31/2017 EACH OCCURRENCE $1 000 000 CLAIMS -MADE OCCUR DAMAGE TO $3000OO MED EXP (Any one person) $10 000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PR POLICY X JECOT- LOC PRODUCTS - COMP/OP AGG $2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED AUTOS NON -OWNED AUTOS A X UMBRELLA LIAB X OCCUR Y Y 34SBWPP2160 1/31/2016 01/31/2017 EACH OCCURRENCE $8 000 000 AGGREGATE $$ 00O 000 EXCESS LIAB CLAIMS -MADE DED X RETENTION $10000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A TAT T E.L. EACH ACCIDENT $ — __ __ E.L. DISEASE - EA EMPLOYEE — -- -- $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ B Professional DPR9723911 7/18/2015 07/18/2016 $1,000,000 per claim Liability $2,000,000 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 is included as Automatic Additional Insured's for your work, acts or omissions which includes completed operations under General Liability and Umbrella Liability but only with respect to liability arising out of the Named Insureds work performed on behalf of the certificate holder and owner. This insurance policies will apply on a primary (See Attached Descriptions) City of Fort Collins, Purchasing PO Box 580 Fort Collins, CO 80522-0000 CA 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 #S17078092/M17076267 ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PBKZP DESCRIPTIONS (Continued from Page 1) and non-contributory basis. A Blanket Waiver of Subrogation applies for General Liability and Umbrella Liability. The Umbrella policy provides excess coverage over General Liability, Automobile Liability and Employers Liability. Please note that Additional Insured status does not apply to Professional Liability. Additional Insured: City of Fort Collins SAGITTA 25.3 (2014/01) 2 Of 2 #S17078092/M17076267