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HomeMy WebLinkAbout366358 JVA INC - INSURANCE CERTIFICATE (6)Client#: 1083121 JVAINC DATE (MM/DD/YYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 4/27/2018 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: USI Colorado, LLC Prof Liab PHONE 800 873-8500 AIC No, Ext): (A/C, No): P.O. Box 7050 E-MAIL ADDRESS: Englewood, CO 80155 �- 800 873-8500 INSURER(S) AFFORDING_ COVERAGE_ NAIC # INSURER A' Travelers Indemnity Company 25658 INSURED JVA, Inc. 1319 Spruce Street Boulder, CO 80302 INSURER B • Plnnacol Assurance Company 41190 INSURER C : XL Specialty Insurance Company 37885 INSURER D : Travelers Property Gas. Co. of America — 25674 INSURER E : 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 CONTRACTOR 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 ADDL INSR SUB WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MMIDDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X X 6809H706548 1510112018 (15111/2019 EACH OCCURRENCE $ 2,000 000 _ CLAIMS -MADE X� OCCUR ROP1AGSFET RENTED MI S Ea occurrence $1 000'000 I MED EXP (Any one person) $1 O 000 PERSONAL & ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY [ X] JECT_LOC GENERAL AGGREGATE $4,000,000 PRODUCTS - COMP/OP AGG $4,000,000 $ OTHER. D AUTOMOBILE LIABILITY X X ,BA1696L578 5101/2018.05/01/201 COMBINED SINGLE LIMIT Ea accident 1,000,000 BODILY INJURY (Per person) _ $ X' ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED X AUTOS ONLY X AUTOS ONLY BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ A XUMBRELLA LIAB X OCCUR X X CUP5113343469 5/01/2018 05/01/201 EACH OCCURRENCE $8 000 000 AGGREGATE $8 000 000 EXCESS LiAB CLAIMS -MADE DED I X RETENTION $10000 $_ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) N / A X 4131403 5/01 /2018 05/01 /201 X PER OTH- E.L. EACH ACCIDENT $1 000 000 E.L. DISEASE - EA EMPLOYEE $1 000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT _ $1,000,000 C Professional X DPR9924214 05101120111 05/01/2011 _ $5,000,000 per claim Liability $5,000,000 annl aggr. Claims Made DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) As required by written contract or written agreement, the following provisions apply subject to the policy terms, conditions, limitations and exclusions: The Certificate Holder and owner are included as Automatic Additional Insured's for ongoing and completed operations under General Liability; Designated Insured under Automobile Liability; and Additional Insureds under Umbrella / Excess Liability but only with respect to liability arising out of the Named Insured work performed on behalf of the certificate holder and owner. (See Attached Descriptions) City Fort SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ty of Cons THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O. Box 580 ACCORDANCE WITH THE POLICY PROVISIONS. Ft. Collins, CO 80522-0000 AUTHORIZED REPRESENTATIVE (a�°VaJ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S23013872/M22999783 NSNZP