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AC"R" CERTIFICATE OF LIABILITY INSURANCE 12124/2015
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 CONTACT
Marsh USA Inc. NAME,
PHONE FAX
216.937.1700 t : A/C No):
200 Public Square ADDRESS:
Suite 1000
Cleveland, OH 44114 __ INSURER(S) AFFORDING COVERAGE NAIC #
J39088-Cas•15-16 _ INSURER A: National Union Fire Insurance Co. of Pittsburgh, PA 19445
INSURED INSURER B : Insurance Company Of The State Of PA 19429
SQUIRE PATTON BOGGS (US) LLP -
SQUIRE PATTON BOGGS (UK) LLP INSURER c : Commerce And Industry Ins Co 19410
ADMINISTRATIVE CENTER INSURER D : N/A N/A
1500 WEST 3RD STREET, STE 450
CLEVELAND, OH 44113-1408 INSURER E :
f"nvCDA!_CC rrGRTICICATF NI IURFR• CLF-004416754-05 RFVISION NUMRFR_1
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
SUER
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MM/DD/YYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
GL 7219312
12/31/2015
12/31/2016
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES Ea occurrence
$ 1,000,000
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER.
X PRO ❑ LOC
POLICY ❑ JECT
OTHER
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000 '000
$
A
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
X X NON -OWNED
HIRED AUTOS AUTOS
CA 9834120
Hired Comp/Coll $1,000
12/31/2015
12/31/2016
COMBINED SINGLE LIMIT
Ea accident
$ 1.000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTYDAMAGE
accident)
$
$
C
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
BE 010338606
12/31/2015
12/31/2016
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 5,000,000
DED X RETENTION $10 000
$
B
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE N
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
WC 025842870 (ADS)
CA WC 069331493
( )
12/31/2015
12/31/2015
12/31/2016
12/31/2016
X SPER TATUTE ORH
-
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
!`CDTICI!^ATF L.Anl 11C0 rANCFI I ATION
The City of Fort Collins, Colorado,
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
A Municipal Corporation
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
P.O. Box 580
ACCORDANCE WITH THE POLICY PROVISIONS.
Fort Collins, CO 80522
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Polly C. Furey l3uy, C.-�••-��
Cc-) IUtftl-ZUT4 ALoUKLJ t,UKrUKA I IUN. All rlgnrs reserve0.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD