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HomeMy WebLinkAbout439705 BELFORD WATKINS GROUP LLC - INSURANCE CERTIFICATE (20)Client#: 1083601 BELFOWAT ACORDT. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYl'Y)7/06/2017 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: USI Colorado, LLC Prof Liab PHONE g00 873-8500 JC A/C, No, Ext : AIC, No P.O. Box 7050 E-MAIL Englewood, CO 80155 ADDRESS: INSURERS) AFFORDING COVERAGE NAIC # 800 873-8500 INSURER A: Sentinel Insurance Company Ltd. 11000 INSURED INSURER B : XL Specialty Insurance Company 37885 Belford Watkins Group, LLC - PO Box 1306, Fort Collins, CO 80522 INSURER C 425 W. Mulberry Street, Suite 207 INSURER D Fort Collins, CO 80521 INSURERS: 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 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 ADDLSUBRI IN-S-R WVD I POLICY NUMBER POLICY EFF (MMIDD POLICY EXP MWDD LIMITS X COMMERCIAL GENERAL LIABILITY 34SBAPM7802 07/08/2018 EACH OCCCURRENCE A 07/08/2017 $1,000,000 CLAIMS MADE 4 OCCUR $1,000,000 PREMISES Ea occcuence MED EXP (Any one person) $10,000 PERSONAL R ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X JECOT 7I LOC PRODUCTS - COMP/OP AGG $ 2,000,000 Is 1,000,000 A OTHER: AUTOMOBILE LIABILITY 34SBAPM7802 _ 7/08/2017 07/08/2018 COMBINED SINGLe LIMIT — Ea accident BODILY INJURY (Per person) _ $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident X HIRED AUTOS X NON -OWNED AUTOS $ $ A Xi UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 34SBAPM7802 07/08/2017 07/08/201 EACH OCCURRENCE $1,000,000 AGGREGATE _ $1,000,000 DED XI RETENTION$10000 _ $ WORKERS COMPENSATION PERTOTH- TA UTE AND EMPLOYERS' LIABILITY Y_/ N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? �_� I N/A E.L. EACH ACCIDENT $ ---- -- E.L. DISEASE - EA EMPLOYEE (Mandatory in NH) $ If yes, describe under DESCRIPTION OF OPERATION_ S below E.L. DISEASE - POLICY LIMIT $ $1,000,000 per claim B _ Professional DPS9912308 3/15/2017 03/15/2018 Liability $1,000,000 annl aggr. Claims Made DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be 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) City of Fort Collins 215 N Mason Fort Collins, CO 80522 t.AN%,r LLA I IVIV 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 (2014101) 1 of 2 #S21082691/M21078640 © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BHRZP DESCRIPTIONS (Continued from Page 1) The General Liability, Automobile Liability, Umbrella/Excess insurance applies on a primary and non contributory basis. A Blanket Waiver of Subrogation applies for General Liability, Automobile Liability and Umbrella/Excess Liability. The Umbrella/Excess Liability policy provides excess coverage over the General Liability and Automobile Liability. Please note that Additional Insured status does not apply to Professional Liability. Additional Insured: City of Fort Collins SAGITTA 25.3 (2014/01) 2 of 2 #S21082691/M21078640