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HomeMy WebLinkAboutLIBERTY COMMON SCHOOL - INSURANCE CERTIFICATE (6)LIBER-8 OP ID: P5 ACORO' DATE (MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE 06/26/2018 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 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 CONTNAME: Karen E. Siwek, CPA Brown & Brown Inc PHONE 970-482-7747 FAX 4532 Boardwalk Dr, Suite 200 A/C No Ext : ac No : 970-484-4165 Fort Collins, CO 80525 E-MAIL Karen E. Siwek, CPA ADDRESS: ksiwek@bbcolorado.com INSURED Liberty Common School 1725 Sharp Point Dr. Fort Collins, CO 80525 INSURER A: Massachusetts Bay Ins Co 22306 INSURER B : Pinnacol Assurance Company 41190 INSURER c : Hanover Insurance Co. 22292 INSURER D : Allmerica Financial Benefit 41840 INSURER F : rOVFRA(:FC rFRTIFIrATF NIIMRFR- RFVISInN NIIMRFP- 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. ILTR TYPE OF INSURANCE L -- - POLICY NUMBER POLICY EFT MM/DD/YYYY POLICY EXP MM/DD/YYYY -- LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR Educator Legal I D4-A957918 07/01/2018 07/01/2019 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 100,000 X GEN'L MED EXP (Any one person) $ 15,000 claims made PERSONAL & ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY ❑ JECT LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OPAGG $ Included Emp Ben. $ 1,000,000 D AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOSF AUTOS AW4-A957923 07/01/2018 07/0112019 (CEO MBINED SINGLE LIMIT accident $ 1,000 00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ C X UMBRELLA LIAB EXCESS LIAB X ri OCCUR CLAIMS -MADE UH4-A957920 07/01/2018 07/01/2019 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 DIED FX RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? a (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 046263 07/01/2018 07/01/2019 OTH- X STATUTE ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEE $ 500,00 E.L.. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Edora Park - The City of Fort Collins, its officers, agents employees volunteers are included as an additional insured if required 6y written contract per HG0001 0605 rGaTIPIrATF unl 1111=0 rANrFi I ATInN CITYFO2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. Risk Management AUTHORIZED REPRESENTATIVE P.O. BOX 580 Karen E. Siwek, CPA Fort Collins, CO 80522-0580 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD