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�® CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/Y03/21/20I8
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 rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
CONTACT
NAME:
Willis of Illinois, Inc.
c/o 26 Century Blvd
P.O. Box 305191
PHONE FAX
A/ No Ext: 1-877-945-7378 A/C No: 1-888-467-2378
E-MAIL
ADDRESS: certificates@willis.com
INSURERS AFFORDING COVERAGE
NAIC#
Nashville, TN 372305191 USA
INSURERA: Zurich American Insurance Company
16535
INSURED
INSURER B: XL Specialty Insurance Company
37885
W.E. O'Neil Construction Co.
1245 W. Washington St.
INSURER C:
INSURER D•
Chicago, IL 60607
INSURER E :
INSURER F :
Cr1VERAC.ER CERTIFICATE NIIMRER- W5543763 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
ADDL
SUBR
POLICY NUMBER
MM/DD/L'CYYYYY
MM/DDNYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS-MADE X OCCUR
A AGE
PREM SESOEa occurRENTEenoe
$ 300,000
MED EXP (Any one person)
$ 10,000
A
PERSONAL& ADV INJURY
$ 1,000,000
Y
GLO-2978893-18
03/31/2018
03/31/2019
GEN'LAGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
X JECT
POLICY n PRO- I LOC
PRODUCTS - COMP/OPAGG
$ 2,000,000
$
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 2,000,000
BODILY INJURY (Per person)
$
X ANY AUTO
A
OWNED SCHEDULED
AUTOS ONLY AUTOS
BAP-2978895-18
03/31/2018
03/31/2019
BODILY INJURY accident Per
( )
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
Comp Ded: Coll Ded:
X 91.000 EX S1.000
PROPERTY DAMAGE
Per accident
$
$
B
X
UMBRELLALIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
US0006505BLI18A
03/31/2018
03/31/2019
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 5,000,000
DED X I RETENTION$ 10000
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y/N
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUDED? No
(Mandatory in NH)
N/A
WC2978892-18
03/31/2018
03/31/2019
X PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE- EA EMPLOYEE
$ 1,000,000
E.L. DISEASE -POLICY LIMIT
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Re: Contractor's License
The following are Additional Insureds on a Non-contributory basis as respects General Liability where required by
written contract with respect to work performed by the Named Insured: City of Fort Collins.
CERTIFICATE HOLDER CANCELLATION
City of Fort Collins
P.O. Box 580
Fort Collins, CO 805220580
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
9)1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
SR ID: 15831214 BATCH: 642170