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HomeMy WebLinkAbout366358 JVA INC - INSURANCE CERTIFICATE (7)Client#: 1083121 JVAINC ACORDTM CERTIFICATE OF LIABILITY INSURANCE DAT4/27120187/2018 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 g00 873-8500 FAX A/C No Et): (A/C, No): P.O. Box 7050 1 E-MAIL -- Englewood, CO 80155 ADDRESS: 800 873-8500 _— INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: --I.- Indemnity Company 25658 INSURED JVA, Inc. 1319 Spruce Street Boulder, CO 80302 INSURER B : Pinnacol Assurimm Company 41190 INSURER C : XL Specialty Insurance Company 37885 INSURER D : Travelers Property Cas. Co. of America 25674 INSURER E : COVERAGES CERTIFICATE NUMBER: REVISION NUMRER- 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. LTR TYPE OF INSURANCE ADDLSUBR NSR WVD POLICY NUMBER MM/DDY EFF MM/DDY EXP LIMITS A X, COMMERCIAL GENERAL LIABILITY X X 6809H706548 5/01/2018 05/01/201 EACH OCCURRENCE $2,000000 CLAIMS -MADE LXXI OCCUR PREMISES TORENTED $1,000,000 MED EXP (Any one person) $1 O 000 PERSONAL & ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY r7X JECT �� LOC GENERAL AGGREGATE $4,000,000 PRODUCTS - COMP/OP AGG $4,000,000 $ _ OTHER: I_ D AUTOMOBILE LIABILITY X X BA1691IL5711 5/01/2018 05/01/201 COMBINF_D SINGLE LIMIT Ea accident 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO X OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ A X: UMBRELLA LIAB X OCCUR X X CUP513343469 5/01/2018 05/01/2019 EACH OCCURRENCE $$ 000 000 AGGREGATE $$ 000 000 EXCESS LIAR CLAIMS -MADE DED X I RETENTION$10000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? FN N / A X _ _ 4131403 0510112018 05/01/201 X SER ORT _ E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below 1 E.L. DISEASE - POLICY LIMIT $1,000,000 C Professional X DPR9924214 5/01/2018 05/01/201 $5,000,000 per claim Liability $5,000,000 annl aggr. Claims Made DESCRIPTION OF OPERATIONS I LOCATIONS / 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 Additionai 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) CERTIFICATE HOLDER CANCELLATION City of Fort Collins Operation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Services ACCORDANCE WITH THE POLICY PROVISIONS. 300 LaPorte Ave., Building B Fort Collins, CO 80521-0000 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) 1 of 2 The ACORD name and logo are registered marks of ACORD #S23013873/M22999783 NSNZP