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HomeMy WebLinkAbout457580 J F SATO & ASSOCIATES - INSURANCE CERTIFICATE (3)Client#: 1084594 JFSAT ACORDT. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYI� 6/23/2017 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 USI Colorado, LLC Prof Liab P.O. BOX 7050 Englewood, CO 80155 800 873-8500 CONTACT NAME: PHONE g00 873-8500 FAX A/C No Ext : A/C No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Hartford Casualty Insurance Co 29424 INSURED INSURERB: XL Specialty Insurance Company 37885 J. F. Sato & Associates, Inc. 5878 So. Rapp Street Littleton, CO 80120 INSURER C INSURER D INSURER E 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 CONTRACTOR 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 INSR SUB WVD POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 34SBWPP2160 1/31/2017 01/3112018 EACH OCCURRENCE $1 OOOOOO CLAIMS -MADE � OCCUR PREMISES TORENTEDs300,O00 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO - POLICY Y JECT LOC I PRODUCTS - COMP/OP AGG $2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per a� dent $ NON -OWNED HIRED AUTOS AUTOS $ A X UMBRELLA LIAB X 1 OCCUR Y Y 34SBWPP2160 1/31/2017 01/3112018 EACH OCCURRENCE s8,000,000 AGGREGATE $$ 000 000 EXCESS LIAB CLAIMS -MADE DED I X RETENTION $10000 $ WORKERS COMPENSATION PER OTH- STATUTEAND FIR EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N / A E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ B Professional Y DPR9915400 0711812017 07/18/201 $1,000,000 per claim Liability $2,000,000 annl aggr. Claims Made DESCRIPTION OF OPERATIONS I LOCATIONS I 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 is included as Automatic Additional Insured's for your work, acts or omissions which includes completed operations under General Liability and Umbrella Liability but only with respect to liability arising out of the Named Insureds work performed on behalf of the certificate holder and owner. This insurance policies will apply on a primary (See Attached Descriptions) [tlaY1121y_\I:4:L91111101a:i City of Fort Collins, Purchasing PO Box 580 Fort Collins, CO 80522-0000 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 (2014/01) 1 of 2 #S20834596/M20834193 ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SINZP DESCRIPTIONS (Continued from Page 1) and non-contributory basis. A Blanket Waiver of Subrogation applies for General Liability and Umbrella Liability. The Umbrella policy provides excess coverage over General Liability, Automobile Liability and Employers 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 #S20834596/M20834193