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HomeMy WebLinkAbout[AU] WORKSHOP LLC - INSURANCE CERTIFICATEClient#: 1090168 AUWORLLC ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYI� 3/29/2016 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 NC E: NAME: US[ Colorado, LLC Prof Liab P.O. Box 7050 Englewood, CO 80155 PHONE g00 873-8500 FAX A/C No Ext : A/C No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # 800 873-8500 INSURER A: Sentinel Insurance Company Ltd. 11000 INSURED [au]workshop, Ilc INSURER B : Hartford Ins Cc of the Midwest 37478 INSURER C: XL Specialty Insurance Company 37885 405 Linden St Fort Collins, CO 80524 INSURER D 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 ADD INSR SUBR WV POLICY NUMBER POLICY EFF M,DD POLICY EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 34SBWPP2901 11/01/2015 11/01/2016 EACH OCCURRENCE $1 000.000 CLAIMS -MADE U OCCUR PREMISES (Ea occu ante) $1,000,000 MED EXP (Any one person) $1 0,000 PERSONAL & ADV INJURY $1,000,000 LAGGREI�GATELIMITAPPLIESPER: GENERALAGGREGATE $2,000,000PR POLICY "i ECOTE LOC r''OTHER: PRODUCTS - COMP/OP AGG $2 OOO 000 $ A AUTOMOBILE LIABILITY Y Y 34SBWPP2901 11/01/2015 11/01/201 Ea acccidentSINGLELIMIT $1,000,000 BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON OWNED X HIRED AUTOS X AUTOS PROPERTY DAMAGE Per accident $ A X UMBRELLALIAB X OCCUR Y Y 34SBWPP2901 11/01/2015 11/01/2016 EACH OCCURRENCE $1 000000 AGGREGATE $1,000,000 EXCESS LIAB CLAIMS -MADE DED I X RETENTION$10000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDEED? (Mandatory in NH) N / A Y 34WECAA0595 03/08,2016 03/08/201 X PER OTH- E.L. EACH ACCIDENT $100000 E.L. DISEASE - EA EMPLOYEE $100000 E.L. DISEASE - POLICY LIMIT $500,000 If yes, describe under DESCRIPTION OF OPERATIONS below C Professional DPR9723526 04/12/2015 04/12/2016 $1,000,000 per claim Liability $1,000,000 annl aggr. Claims Made DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe 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 and owner are included as Automatic Additional Insured's for ongoing and completed operations under General Liability; Designated Insured under Automobile Liability; and Additional Insureds under Umbrella / Excess Liability but only with respect to liability arising out of the Named Insured work performed on behalf of the certificate holder and owner. (See Attached Descriptions) ULH I II-IL;A I t HULUt:K City of Fort Collins PO Box 580 Fort Collins, CO 80522-0580 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 #S17524464/M17498662 © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD RZEZP SAGITTA 25.3 (2014/01) 2 of 2 #S17524464/M17498662