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HomeMy WebLinkAbout109005 POUDRE VALLEY AIR OF NORTHERN COLORADO - INSURANCE CERTIFICATE (6)ACORU® �,. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDYYYY) 06/01/2018 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACTDana Stewart, CIC, CISR NAME: Flood and Peterson AHCNNo Ext : (970) 266-7149 C. No): (970) 506-6845 E-MAIL DStewartefloodpeterson.com ADDRESS: PO Box 578 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Employers Mutual Casualty Company 21415 Greeley CO 80632 INSURED INSURER B : Plnnacol Assurance 41190 INSURER C : Poudre Valley Air Of Northern INSURER D : Colorado. Inc INSURER E : 2416 Donella Court. Suite A INSURER F : Fort Collins CO 80524 COVERAGES CERTIFICATE NUMBER: GL/AU/XS x10/18 WC x71 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. IPOLICY LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDNY F EXP MMIDD Y YY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1.000,000 CLAIMS -MADE ® OCCUR DAMAGE TO RENT1=17- PREMISES Ea occurrence S 500.000 MED EXP (Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 A 5X77586 10,117/2017 10/17/2018 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE y 2,000,000 POLICY ] PE� LOC PRODUCTS - COIv9P!OP AGG $ 2.000,000 S OTHER: AUTOMOBILE LIABILITY COP.16tNED SINGLE LIMIT i Ea accident $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS 5X77586 10/17/2017 10/17/2018 BODILY INJURY (Per accidenq $ PROPERTY DAMAGE Per accident S HIRED NON -OWNED AUTOS ONLY AUTOS ONLY 11 S UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 3,000,000 AGGREGATE $ 3,000,000 A EXCESS LIAB CLAIMS -MADE 5X77586 10/17/2017 10/1712018 DED I X1 RETENTION $ 0 $ 1 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y t N ANYCERWEMBERPARTNER/EXECUTIVE ❑ OFFICERrMEMBER EXCLUDED? (Mandatory in NH) NIA 4074340 07/01/2018 07/01/2019 PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If ves, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT y 1.000,000 DESCRIPTION OF OPERATIONS i LOCATIONS t VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins Home Efficiency Program ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 AUTHORIZED REPRESENTATIVE Fort Collins CO 80522 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD