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HomeMy WebLinkAboutSURROUNDINGS LLC - INSURANCE CERTIFICATE (3)SURRLLC-01 LPREWITT CERTIFICATE OF LIABILITY INSURANCE FDATE(M 3/301201YYY) 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 CONTACT NAME: PFS Insurance Group PHONE FAX 4848 Thompson Parkway Suite 200 WC No Ext : (970) 635-9400 A/c No : (970) 635-9401 Johnstown, CO 80534 noul ESS: info@mypfsinsurance.com INSURER(S) AFFORDING COVERAGE NAIC 0 INSURER A: Acuity insurance Co. 14184 INSURED INSURER B Surroundings LLC NSURERC: 6121 E Harmony Rd INSURERD: Fort Collins, CO 80525 INSURER E : INSURER F : C0VFRA[.FS CFRTIFICATF MI IMRFR• RG\/ICInKi w IMRCo- 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. LTR TYPE OF INSURANCE NSD WVD POLICY NUMBER MM DD/YYri MLICY EFF POLICY D NYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR X39278 04/01/2016 04/01/2017 PREMISES Ea occurrence $ 300,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- ❑ JECT LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,00 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident)$ 1,000,00 X BODILY INJURY (Per person) $ A ANY AUTO X39278 04/01/2016 04/01/2017 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 X AGGREGATE $ A EXCESS LIAB CLAIMS -MADE X39278 04/01/2016 04/01/2017 DED I X I RETENTION$ 0 Aggregate $ 1,000,00 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/IJ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A PER I OTH- STATUTE I I ER $ - E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYE (Mandatory in NH) If yes, describe under $ E.L. DISEASE -POLICY LIMIT 1 DESCRIPTION OF OPERATIONS below $ A Personal Property X39278 04/01/2016 04/01/2017 $500 Deductible 450,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION City of Fort Collins 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 Z�l © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD