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Home My WebLink About501351 WORKSPACE INNOVATIONS LTD - INSURANCE CERTIFICATE (4)A16-1�C"Rbr CERTIFICATE OF LIABILITY INSURANCE ATE (MM/DDNYY Fl/27/2016Y) 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 Cathy Baker NAME: . Moody Insurance Agency, Inc. 8055 East Tufts Avenue PHONENo, (303) 824-6600 FAX No: (303)370-0118 E-MAIL Cathy.baker mood ins.coAl ADDRESS: Y INSURERS AFFORDING COVERAGE NAIC # Suite 1000 INSURERA:Union Insurance Co 25844 Denver CO 80237 INSURED INSURERB:Pinnacol Assurance 41190 INSURERC: Workspace Innovations, LLC 4414 E. Harmony Road #100 INSURERD: INSURER E : _ INSURERF: Fort Collins CO 80528 COVERAGES CERTIFICATE NUMBER:16-17 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 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 A L WVD U R POLICY NUMBER MMIDDNYYY MM/DD/YF POLICY Yri LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR EACH OCCURRENCE ' $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 X CPA 3070334-21 9/1/2015 9/1/2016 PERSONAL B ADV INJURY $ 11000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY ❑ JEI° D LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 Employee Benefits $ 1,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT E $ 1,000,000 X BODILY INJURY (Per person) $ A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X CPA 3070334-21 9/1/2015 9/1/2016 BODILY INJURY Per accident ( ) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ Underinsured motorist $ Included UMBRELLA LIAR EACH OCCURRENCE $ HOCCUR AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below N/A 4129130 2/1/2016 2/1/2017 ER OTH- X TER ER E.L. EACH ACCIDENT $ 11000,000 E.L. DISEASE - EA EMPLOYE $__ 1, 000, 000 E.L. DISEASE - POLICY LIMIT 1 $ 1,000.000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) %,Gn I jr-R-N I F_ rlvLur-ri L ANtotLLA I IUN City of Fort Collins Attn: Jennifer Harvey P.O. 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 Cathy Baker/CATBAK ACORD 25 (2014/01) INS025 (201401) 91988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD