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HomeMy WebLinkAboutALM2S - INSURANCE CERTIFICATE (5)ALLER-3 OP ID: P5 ACORO" DATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 03/28/2016 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 CONTANAME: CT Karen E. Siwek, CPA _ Brown & Brown Inc PHONE 970-482-7747 FAX 4532 Boardwalk Dr, Suite 200 Arc No Ell: IAIc, No): 970-484-4165 Fort Collins, CO 80525 Karen E. Siwek, CPA ADDRESS: ksiwek@bbcolorado.com INSURERS AFFORDING COVERAGE NAIC S INSURER A:Pinnacol Assurance Company 41190 INSURED alm2s INSURERB:Westfleld Insurance Company 24112 712 Whalers Way, Ste. B-100 INSURER C: Endurance American Specialty 41718 Fort Collins, CO 80525 INSURER D : INSURER E: INSURER F : CC)VFRAil CFRTIFICATF NI IMRFR• RFVLQICAN 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. INSR TYPE OF INSURANCE IADDL SUBRr - - - POLICY EFF POLICY EXP LIMITS LTR IN POLICY NUMBER MM/DD/YYYY MM/DDNYYY B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE LJ OCCUR X BOP3719966 04/01/2016 04/01/2017 DAMAGEPREMISESS( RENTED Ea occurrence 1000O $ , MED EXP (Any one person) $ 5,00 X EBL/EPL PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,00 Emp Ben. $ 1,000,00 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,00 BODILY INJURY (Per person) $ B X ANY AUTO X BOP3719966 04/01/2016 04/01/2017 ALL OWNED SCHEDULED AUTOS AUTOS $ BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS )( UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,00 AGGREGATE $ 2,000,00 B EXCESS LIAB CLAIMS -MADE BOP3719966 04/01/2016 04/01/2017 DED FX RETENTION $ 0 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED) (Mandatory in NH) N / A 1951272 04/01/2016 W0112017 PER OTH- X STATUTE I I ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below $ 1,000,1)0 E.L. DISEASE - POLICY LIMIT C Professional DPL10004431602 04/01/2016 04/01/2017 Ea Claim 2,000,00 Aggregate 2,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) City of Fort Collins and Wattle and Daub Contractors are Additional Insured with respect to General Liability and Automobile Liability. Project: 7666 Bobcat Ridge Historic Buildings Rehabilitation CITYFC2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE Karen E. Siwek, CPA © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD NOTEPAD ALLE: P INSURED'S NAME alm2s OP ID: 5 When required by written contract the following applies: anket Additional Insured BP 0451 imary and Non -Contributory BP 1488 anket Waiver of Subrogation BP 0497 ditional Insured - State or Governmental Agency or Subdivision or litical Subdivision - Permits or Authorization Relating to Premises 0407 anket Additional Insured - Owners. Lessees or Contractors with ditional Insured Requirements for Parties in Construction Contract - 0451 tomobile - anket Additional Insured CA 0778 anket Waiver of Subrogation CA 0444 lla - Following Form rs Compensation - Blanket Waiver of Subrogation 359-B PAGE 2 Date 03/28/2016 ALLER-3 OP ID: P5 ACORO" DATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 03/28/2016 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 CONTANAME: CT Kciren E. Siwek, CPA Brown 8r Brown Inc PHONE FAX 4532 Boardwalk Dr, Suite 200 AIC No Ext :970-482-7747 (A/c, No): 970-484-4166 Fort Collins, CO 80525 E-MAIL Karen E. Siwek. CPA ADDRESS: ksiwek@bbcolorado.com INSURED alm2s 712 Whalers Way, Ste. B-100 Fort Collins, CO 80525 INSURERS AFFORDING COVERAGE NAI INSURER A: Pinnacol Assurance Company 41190 INSURER B: Westfield Insurance Company 24112 INSURER C: Endurance American Specialty 41718 INSURER D : INSURER E: INSURER F : nr%VFRAnPQ r`FRTIFIRATF NI IMRFR• RFVIRIAN NIIMRFRc 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 TYPE OF INSURANCE DDL UBR, POLICY NUMBER MM DD/YYYY MM DD/YYYY LIMITS LTR B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE -' 1 OCCUR X BOP3719966 04/01/2016 04/01/2017 DAMAGE TO RENTED PREMISES Ea occurrence $ - 100�00 MED EXP (Any one person) $ 5,00 X EBL/EPL PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY D PRO JECT E]LOC PRODUCTS - COMP/OP AGG $ 2,000,00 Emp Ben. $ 1,000,00 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,00 BODILY INJURY (Per person) B X ANY AUTO BOP3719966 04/01/2016 04/01/2017 $ BODILY INJURY (Per accident) ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS $ $ PROPERTY DAMAGE Peraccident) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,00 AGGREGATE $ 2,000,00 B EXCESS LIAB CLAIMS -MADE BOP3719966 04/01/2016 04/01/2017 DED X RETENTION $ 0 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N 1951272 04/01/2016 04/01/2017 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N / A _ $ 1,000,00 E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ 1,OD0,00 If yes describe under DESCRIPTION OF OPERATIONS below C Professional DPL10004431602 04/01/2016 04/01/2017 Ea Claim 2,000,00 Aggregate 2,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Fort Collins is named additional insured with regards to general liability. 2 Lht\ I; CITYFT5 City of Fort Collins Purchasing Division PO Box 580 Fort Collins, CO 80522 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 Karen E. Siwek, CPA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD NOTEPAD ALLER-3 PAGE 2 INSURED'S NAME alm2S OP ID: P5 Date 03/28/2016 When required by written contract the following applies: Blanket Additional Insured BP 0451 Primary and Non -Contributory BP 1488 Blanket Waiver of Subrogation BP 0497 Additional Insured - State or Governmental Agency or Subdivision or Political Subdivision - Permits or Authorization Relating to Premises BP 0407 Blanket Additional Insured - Owners. Lessees or Contractors with Additional Insured Requirements for Parties in Construction Contract - BP 0451 Automobile - B1anket Additional Insured CA 0778 Blanket Waiver of Subrogation CA 0444 Umbrella - Following Form Workers Compensation - Blanket Waiver of Subrogation 359-B i