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HomeMy WebLinkAboutNSF IINTERNATIONAL - INSURANCE CERTIFICATEDATE (MM/DD/YYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE 1 6/30/2017 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 have ADDITIONAL INSURED provisions or 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 riahts to the certificate holder in lieu of such endorsement(s). PRODUCER wry ins, i NAME:. Amy L. Mlcallef, CIC, CISR, AIS, LIC, AAI Marsh & McLennan Agency LLC PHONE FAX 15415 Middlebelt Road fA<C INC4Ext,: 734-525-2445 (A/C Not 734-525_-1841 E-MAIL amicallef@mma-mi.com Livonia MI 48154-3805 ADDRESS; .com @mm— _ INSURER A: Federal Insurance Company 120281 INSURED NSFINTER I INSURERB:ACE American Insurance Company 122667 NSF International I INSURERC: c/o Mr. Michael Walsh - 789 North Dixboro Road INSURERD: Ann Arbor MI 48105 1 INSU_RER_E : rr1VFRAnl7q r;=PTIFICATF NIIMRFR• 291083136 RFVIRIrIkI All 11i 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 ADDL SUBRi POLICY EFF POLICY EXP LTR I TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y 35854081 'I7/1/2017 7/1/2018 EACH OCCURRENCE $1,000,000 J CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES E_aoccurrence) $1,000,000 $10,000 MED EXP (Any one person) $1,000,000 PERSONAL & ADV INJURY GEN'L GENERAL AGGREGATE $2,000,000 AGGREGATE LIMIT APPLIES PER: PRO - POLICY ECT X I LOC PRODUCTS - COMP/OP AGG $2,000,000 $ OTHER: A AUTOMOBILE LIABILITY Y 73538064 7/1/2017 7/1/2018 COMBINED Ea accident_ $1,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY PROPERTY DAMA E Per accident $ A X UMBRELLA LIAB X OCCUR 79853485 7/1/2017 7/1/2018 EACH OCCURRENCE $10,000,000 AGGREGATE EXCESS LIAB CLAIMS -MADE $10,000,000 DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE 71722532 7/1/2017 7/1/2018 X PER DTH- STATUTE ER E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED> ❑ N/A E.L. DISEASE - EA EMPLOYEd $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $1,000,000 B !I Professional Liability Retro Date 01/01/1944 G27882067001 7/1/2017 7/1/2018 (Limit $15,000,000 Retention - Non Mass $250,000 Mass/Class Action $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Fort Collins, its officers, agents and employees are included as additional insureds for commercial general liability insurance to the extent provided in the attached form #80-02-2367 and for auto liability to the extent provided in the attached form #16-02-0292. The insurance carrier will provide the Certificate Holder with direct notice of cancellation to the extent provided in the attached form #80-02-9779 for commercial general liability and in attached form #16-02-0303 for auto liability. CERTIFICATE HOLDER CANCELLATION The City of Fort Collins Attn: Matt Zoccali 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL AUTOMOBILE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM This endorsement modifies the Business Auto Coverage Form. 1. EXTENDED CANCELLATION CONDITION C. Paragraph A.2.b. --CANCELLATION of the COMMON POLICY CONDITIONS form IL 00 17 is deleted and replaced with the following: b. 60 days before the effective date of cancellation if we cancel for any other reason. 2. BROAD FORM INSURED A. Subsidiaries and Newly Acquired or Formed Organizations As Insureds The Named Insured shown in the Declarations is amended to include: 1. Any legally incorporated subsidiary in which you own more than WY6 of the voting stock on the effective date of the Coverage Form. However, the Named Insured does not include any subsidiary that is an "insured" under any other automobile policy or would be an "insured" under such a policy but for its termination or the exhaustion of its Limit of Insurance. 2. Any organization that is acquired or formed by you and over which you maintain majority ownership. However, the Named Insured does not include any newly formed or acquired organization: (a) That is an "insured" under any other D. automobile policy; (b) That has exhausted its Limit of Insurance under any other policy; or (c) 180 days or more after its acquisition or formation by you, unless you have given us written notice of the acquisition or formation. Coverage does not apply to "bodily injury" or "property damage"that results from an "accident" that occurred before you formed or acquired the organization. B. Employees as Insureds Paragraph A. 1. — WHO IS AN INSURED — of SECTION 11 —LIABILITY COVERAGE is amended to add the following: d. Any "employee" of yours while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs. Lessors as Insureds Paragraph A.I. — WHO IS AN INSURED —of SECTION 11 —LIABILITY COVERAGE is amended to add the following: e. The lessor of a covered "auto" while the "auto" is leased to you under a written agreement if. (1) The agreement requires you to provide direct primary insurance for the lessor; and (2) The "auto" is leased without a driver. Such leased "auto" will be considered a covered "auto" you own and not a covered "auto" you hire. However, the lessor is an "insured" only for "bodily injury" or "property damage" resulting from the acts or omissions by: 1. You; 2. Any of your "employees" or agents; or 3. Any person, except the lessor or any "employee' or agent of the lessor, operating an "auto" with the permission of any of 1. and / or 2. above. Persons And Organizations As Insureds Under A Written Insured Contrad Paragraph A.1 — WHO IS AN INSURED —of SECTION 11 —LIABILITY COVERAGE is amended to add the following: f. Any person or organization with respect to the operation, maintenance or use of a covered "auto", provided that you and such person or organization have agreed under an express provision in a written insured contract", written agreement or a written permit issued to you by a governmental or public authority to add such person or organization to this policy as an "insured". However, such person or organization is an "insured" only: Form: 16-02-0292 (Rev. 4-11) Page 1 of 3 "Includes copyrighted material of Insurance Services Office, Inc. with its permission" (1) with respect to the operation, maintenance or use of a covered "auto"; and (2) for "bodily injury" or "property damage" caused by an "accident" which takes place after: (a) You executed the "insured contract" or written agreement; or (b) The permit has been issued to you. 3. FELLOW EMPLOYEE COVERAGE EXCLUSION B.5. - FELLOW EMPLOYEE -of SECTION 11-LIABILITY COVERAGE does not apply. 4. PHYSICAL DAMAGE - ADDITIONAL 'TEMPORARY TRANSPORTATION EXPENSE COVERAGE Paragraph AA.a. -TRANSPORTATION EXPENSES -- of SECTION III -PHYSICAL DAMAGE COVERAGE is amended to provide a limit of $50 per day for temporary transportation expense, subject to a maximum limit of $1,000. 5. AUTO LOAN/LEASE GAP COVERAGE Paragraph A. 4. -COVERAGE EXTENSIONS - of SECTION III - PHYSICAL DAMAGE COVERAGE is amended to add the following: c. Unpaid Loan or Lease Amounts In the event of a total "loss" to a covered "auto", we will pay any unpaid amount due on the loan or lease for a covered "auto" minus: 1. The amount paid under the Physical Damage Coverage Section of the policy; and 2. Any: a. Overdue loan/lease payments at the time of the "loss"; b. Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; c. Security deposits not returned by the lessor: d. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and e. Carry -aver balances from previous loans or leases. We will pay for any unpaid amount due on the loan or lease if caused by: 1. Other than Collision Coverage only if the Declarations indicate that Comprehensive Coverage is provided for any covered "auto"; 2. Specified Causes of Loss Coverage only if the Declarations indicate that Specified Causes of Loss Coverage is provided for any covered "auto"; or 3. Collision Coverage only if the Declarations indicate that Collision Coverage is provided for any covered "auto. 6. RENTAL AGENCY EXPENSE Paragraph A. 4. -COVERAGE EXTENSIONS -of SECTION III -PHYSICAL DAMAGE COVERAGE is amended to add the following: d. Rental Expense We will pay the following expenses that you or any of your "employees" are legally obligated to pay because of a written contract or agreement entered into for use of a rental vehicle in the conduct of your business: MAXIMUM WE WILL PAY FOR ANY ONE CONTRACT OR AGREEMENT: 1. $2,500 for loss of income incurred by the rental agency during the period of time that vehicle is out of use because of actual damage to, or "loss" of, that vehicle, including income lost due to absence of that vehicle for use as a replacement; 2. $2,500 for decrease in trade-in value of the rental vehicle because of actual damage to that vehicle arising out of a covered "loss"; and 3. $2,500 for administrative expenses incurred by the rental agency, as stated in the contract or agreement. 4. $7,500 maximum total amount for paragraphs 1., 2. and 3, combined. 7. EXTRA EXPENSE -BROADENED COVERAGE Paragraph A.4. -COVERAGE EXTENSIONS -of SECTION III -PHYSICAL DAMAGE COVERAGE is amended to add the following: e. Recovery Expense We will pay for the expense of returning a stolen coverer "auto" to you. 8. AIRBAG COVERAGE Paragraph B.3.a. - EXCLUSIONS -of SECTION III - PHYSICAL DAMAGE COVERAGE does not apply to the accidental or unintended discharge of an airbag. Coverage is excess over any other collectible insurance or warranty specifically designed to provide this coverage. 9. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT - BROADENED COVERAGE Paragraph C.2. -LIMIT OF INSURACE - of SECTION III - PHYSICAL DAMAGE is deleted and replaced with the following: 2. $2,000 is the most we will pay for "Loss" in any one "accident" to all electronic equipment that reproduces, receives or transmits audio, visual or data signals which, at the time of "loss", is: a. Permanently installed in or upon the covered "auto" in a housing, opening or other location that is not normally used by the "auto" manufacturer for the installation of such equipment; b. Removable from a permanently installed housing unit as described in Paragraph 2.a. above or is an integral part of that equipment; or Form: 16-02-0292 (Rev. 4-11) Page 2 of 3 "Includes copyrighted material of Insurance Services Office, Inc. with its permission" COMMERCIAL AUTOMOBILE THIS ENDORSEMENT CHANGESTHE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION SCHEDULED PERSON(S) OR ORGANIZATION(S) This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGECOVERAGEFORM TRUCKERS COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. SCHEDULE Name of Person(s) or Organization(s): IF YOU ARE OBLIGATED,PURSUANT TO A WRITTEN CONTRACT OR AGREEMENT,TO PROVIDE PERSON(S)OR ORGANIZATION(S)WITH NOTICE OF CANCELLATION, THEN WE WILL NOTIFY SUCH PERSON(S)OR ORGANIZATION(S)PROVIDED THAT WITHIN 15 DAYS OF THE DATE WE SENT NOTICE OF CANCELLATION TO THE FIRST NAMED INSURED,THE FIRST NAMED INSURED OR PRODUCER OF RECORD PROVIDES US WITH A SPREADSHEET CONTAINING THE NAME,MAILING ADDRESS AND,IF AVAILABLE,E—MAIL ADDRESS OF THE PERSON(S)OR ORGANIZATION(S) Address: Under Common Policy Conditions the following condition is added: NOTICE OF CANCELLATION —SCHEDULED PERSON(S) OR ORGANIZATION(S) When we cancel this policy we will notify the person(s) or organization(s) described in the SCH E DU LE at least 30 days ( 10 days in the event of nonpayment of premium) in advance of the cancellation date. Any failure by us to notify such person(s) or organization(s) will not: • Impose any liability or obligation of any kind upon us; or • Invalidate such cancellation. 16-02-0303 (Ed. 5-11) Page 1 of I Liability Insurance Endorsement Policy Period Effective Date Policy Number Insured Name of Company Date Issued This Endorsement applies to the following forms: GENERAL LIABILITY Under Who Is An Insured, the following provision is added Who Is An Insured Additional Insured - Persons or organizations shown in the Schedule are insureds; but they are Insureds only if you are Scheduled Person obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by Or Organization this policy. However, the person or organization is an insured only: if and then only to the extent the person or organization is described in the Schedule; to the extent such contract or agreement requires the person or organization to be afforded status as an insured; for activities that did not occur, in whole or in part, before the execution of the contract or agreement; and with respect to damages, loss, cost or expense for injury or damage to which this insurance applies. No person or organization is an insured under this provision: that is more specifically identified under any otherprovision of the Who Is An Insured section (regardlessof any limitation applicable thereto). with respect to any assumption of liability (of anotherperson or organization)by them in a contract or agreement. This limitation does not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contract or agreement. Liability Insurance Additional Insured - S �r '� anon continued Farm 8"2-2367 (Rev. 5-07) Endorsement �Page t Liability Endorsement (continued) Under Conditions, the following provision is added to the condition titled Other Insurance. Conditions Other Insurance — If you are obligated, pursuant to a contract or agreement, to provide the person or organization Primary, Noncontributory shown in the Schedule with primary insurance such as is afforded by this policy, then in such case Insurance — Scheduled this insurance is primary and we will not seek contribution from insurance available to such person Person Or Organization or organization. Schedule Persons or organizations that you are obligated, pursuant to a contract or agreement, to provide with such insurance as is afforded by this policy. All other terms and conditions remain unchanged Authorized Representative Q-0NN� Liabitlty Insurance Addilknal Insured - ScheWwm9T�ation last page Form 80-02-2367 (Rev. 5-07) Endorsement Page 2 Policy Conditions Endorsement Policy Period Effective Date Policy Number insured Name of Company Date Issued •p}:w%r::afi{•f k.Yk6ir0Ya.'; •r'A4 Y.-!L;It! ."n v—,. . .- ,p..::,.. ........ a: x.e. n,•+:�n,... •,n':..-xxtl. ...�•,r:.i "r}M`: •.ta"11:r,I This Endorsement applies to the following forms: COMMON POLICY CONDITIONS Y:xia..9ntiMi,'.,.•LY:I •.ia^.,ti;,YAit"'Mn':,..+¢>: •� •.-:+'•a:":%'•..w+. "•.r%h.":v 1^C. . ...1YM1:- i.�ltt' ,�..._ ... Vd':'.Ms.tiM1..`Y .4 .Kc.Y....... .N.A 1A... .A.4 Under Conditions, the following condition is added. Conditions Notice Of Cancellation When we cancel this policy for any reason, other than non-payment of premium, we will notify 7o Scheduled Persons person(s) or organization(s) shown in the Schedule at least 30 days in advance of the cancellation Or Organizations When date. We Cancel Any failure by us to notify such person(s) or organization(s) will not: impose any liability or obligation of any kind upon us; or invalidate such cancellation, Y. -;J%l: :.1::1.4 4:%1t.l:'. r-. 0 S R.,•R,,::fi:.. ra :: :i •;,.Lt ;::..tp-.. Schedule If you are obligated, pursuant to a written contract or agreement, to provide person(s) or organization(s) with notice of cancellation, then we will notify such person(s) or organization(s) provided that within 15 days of the date we send notice of cancellation to the first named insured, the first named insured or producer of record provides us with a spreadsheet containing the name, mailing address and, if available, e-mail address of the person(s) or organization(s). All other terms and conditions remain unchanged. Reference Copy Policy Conditions Notice Of Cancellation To scheduled Persons Or anizations (Except Non -Payment Of Premium) continued Form 8"2-9779 (Ed. 3-11) Endorsement Page 1 Conditions (continued) Authorized Representative Reference Copy Policy Conditions Notice Of Cancollation To Scheduled Persons Or Organr lions (Except Non -Payment Of Premrium) fast page Form 60-02-9779 (Ed. 3-11) Endorsoment Page 2