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HomeMy WebLinkAboutLIBERTY COMMON SCHOOL - INSURANCE CERTIFICATE (7)LIBER-8 OP ID: P5 '44C"R1J CERTIFICATE OF LIABILITY INSURANCE FDA06/26/201TE Y) 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 Brown 8 Brown Inc 4532 Boardwalk Dr, Suite 200 CONTACT Karen E. Siwek, CPA PHONE 970-482-7747 FAX A/c No Ext: A/C No: 970-484-4165 Fort Collins, CO 80525 Karen E. Siwek, CPA E-MAIL ksiwek@bbcolorado.com ADDRESS: INSURERS) AFFORDING COVERAGE NAIC 0 INSURER A: Massachusetts Bay Ins Co 22306 INSURED Liberty Common School INSURER B : Pinnacol Assurance Company 41190 Sharp Point Dr. Fort Collins, CO 80525 Fort INSURER C : Hanover Insurance Co. 22292 INSURER D : Allmerica Financial Benefit 41840 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 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 POLICY NUMBER POLICY MMI�D�YY -- LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I -XI OCCUR Educator Legal X ZD4-A957918 07/01/2018 07/01/2019 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 100,000 X MED EXP (Any one person) $ 15,000 claims made PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- LOC POLICY EPRO JECT OTHER: GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP/OP AGG $ Include Emp Ben. $ 1,000,000 D AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS W4-A957923 07/01/2018 07/01/2019 COMBINED SINGLE LIMIT a Ea ccident $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ $ PROPERTY DAMAGE Per accident C. X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE UH4-A957920 07/01/2018 07/01/2019 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 DIED I X I RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N IA 4046263 07/0112018 07/01/2019 I PER 0 H- X STATUTE ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEO $ 500,00 E.L. DISEASE - POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) RE: Liberty Common High School Torch Trek The City of Fort Collins, Its officers agents, employees & volunteers are included as an additional insured W required by written contract per HG 0001 0605 C City of Fort Collins Risk Management P.O. Box 580 Fort Collins, CO 80522-0580 CITYFOR 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 Karen E. Siwek, CPA © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD