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Home My WebLink About499821 STRUCTURES INC - INSURANCE CERTIFICATE (5)ACoR& CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/18/2015 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 Quinn, NAME: Julie CIC Moody Insurance Agency, Inc. 8055 East Tufts Avenue PHONro,Extr (303)824-6600 Fyaxc No:(303)370-0118 E-MAIL ins.com ulie. uinn@mood ADDRESS: julie.quinn@moodyins.com Suite 1000 INSURERS AFFORDING COVERAGE NAIC# INSURERA:Travelers Prop Cas Co of America 25674 Denver CO 80237 INSURED INSURERB:Travelers Indemnity Company 25658 INSURERC:Pinnacol Assurance Structures, Inc. 4 Inverness Ct E Ste 250 _ INSURERD: INSURER E : Englewood CO 80112 INSURERF: COVERAGES CERTIFICATE NUMBER:15-16 with Forms REVISION NUMRFR: 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 I TYPE OF INSURANCEwan AD L U W vvvn i POLICY NUMBER POLICY EFF MWDD/YYY POLICY EXP M NYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR EACH OCCURRENCE $ 11000,000 DAMAGE TO RENTED PREMISES Ea occurrence)$ 300,000 MED EXP (Any oneperson) $ 5,000 X DTC0324DS41115TIL 12/31/2015 12/31/2016 PERSONAL 8 ADV INJURY $ 11000,000 Additional Insured status GENT AGGREGATE LIMIT APPLIES PER: POLICY JECT LOC GENERAL AGGREGATE $ 2,000,000 applies only to the extent provided in form PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER CGD246 AUTOMOBILE LIABILITY Ca MINED SINGLE LIMIT $ 1,000,000 X BODILY INJURY (Per person) $ $ B ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS DT810324DS41115TIL 12/31/2015 12/31/2016 BODILY INJURY Per accident ( ) NON -OWNED HIRED AUTOS X AUTOS _ $ X PROPERTY DAMAGE Per a.Zt Medical Payments $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4, 000, 000 AGGREGATE $ 4,000,000 A EXCESS LIAB CLAIMS -MADE DED I X I RETENTION$ 10 000 $ DTSXCUP322SD280615TIL 12/31/2015 12/31/2016 C WORKERS COMPENSATION, AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 4188248 l/1/2016 1/1/2017 X E OTH- STATUT ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 11000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 I .- — I T DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: 7338 Troutman Court East #250 City of Fort Collins and State of Colorado are named as an additional insured with respect to General Liability. v ter, r n wh r r- r I,AIVt+LLLA I IVIV City of Fort Collins Financial Services Purchasing Division 215 N Mason St, 2nd floor 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 Quinn, CIC/JULQUI ACORD 25 (2014/01) INS025 (201401) 01988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD