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HomeMy WebLinkAboutLIBERTY COMMON SCHOOL - INSURANCE CERTIFICATE (8)LIBER-8 OP ID: P5 ACORO' DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 1 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 CONTANAME: CT Karen E. Siwek, CPA _ Brown 8 Brown Inc PHONE 970-482_7747 FAX 4532 Boardwalk Dr, Suite 200 A/C No Ell: A/c No: 970-484-4165 Fort Collins, CO 80525 E-MAIL E Karen E. Siwek, CPA $S: ksiwek@bbcolorado.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Massachusetts Bay Ins Co 22306 INSURED Liberty Common School INSURER B : Plnnacol Assurance Company 41190 _ Sharp Point Dr. Fort Collins, CO 80525 INSURER c : Hanover Insurance Co. 22292 Fort — ----- INSURER D :Allmerica Financial Benefit 41840 INSURER E: INSURER F : r r)VFRAr:FR r l:PTIFICATF NIIMRFR• RFVISInN Nt1MRFR- 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 OF INSURANCE L ADDTYPE U POLICY NUMBER MM! DIYYYY MM/ DIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE I X1 OCCUR D4-A957918 07/01/2018 07/01/2019 PREMISES Ea occurrence $ 100,00114 X MED EXP (Any one person) $ 15,000 Educator Legal claims made PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY ❑ PRO- ❑ JECT LOC PRODUCTS - COMP/OP AGG $ Include Emp Ben. $ 1,000,00 OTHER: AUTOMOBILE LIABILITY MBINED SINGLE LIMIT EaCOaccident $ 1, 000,00_ BODILY INJURY (Per person) $ D X ANY AUTO AW4-A957923 07/01/2018 07/01/2019 ALL OWNED SCHEDULED AUTOS _ AUTOS -- NON -OWNED HIRED AUTOS AUTOS BODILY INJURY (Per accident) $ $ PROPERTY DAMAGE Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,00 C EXCESS LIAB CLAIMS -MADE UH4-A957920 07/01/2018 07/01/2019 DIED I X RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A 046263 07/01/2018 07/01/2019 X PER TH- STATUTE ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEE $ 500,00 1t yes, describe under DESCRIPTION OF OPERATIONS below 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 -to -Liberty 5K Run/Walk - The City of Fort Collins, its officers, agents, employees & volunteers are included as an additional insured if required by written contract per HG0001 0605 UtK I It•IUA 1 t HULUtK CITYFOR City of Fort Collins Risk Management P.O. Box 580 Fort Collins, CO 80522-0580 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