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HomeMy WebLinkAbout113275 ALM2S - INSURANCE CERTIFICATE (6)ALM2S-1 OP ID: P5 ACORO` CERTIFICATE OF LIABILITY INSURANCE FDATE / 03/211221/2018 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 CONTACT Karen Siwek Brown & Brown Inc NAME: 4532 Boardwalk Dr, Suite 200 HONE No Ezt :970-494-4667 No ; 970-484-4165 Fort Collins, CO 80525 E-MAIL Karen E. Siwek, CPA ADDRESS: ksiwek@bbcolorado.com INSURED alm2s 712 Whalers Way, Ste. B-100 Fort Collins, CO 80525 INSURERS) AFFORDING COVERAGE NAIC INSURER A: Plnnacol Assurance Company 41190 INSURER B: Westfield Insurance Company 24112 INSURER C : Admiral Insurance Comoanv 24856 INSURER D : INSURER E : INSURER F : Cr1VPPAnPA r F=RTIFICATF NIIMRFR• RFVISIr)N NIIMRFR- 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 BR POLICY NUMBER MPOLICY DYYYY MM/L DDIYYYY LIMITS B X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I X I OCCUR X BOP3719966 04/01/2018 04/01/2019 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,00 X EBL/EPL PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PEI° LOC OTHER: GENERAL AGGREGATE $ 2,000,00 PRODUCTS -COMPIDPAGG $ 2,000,00 Emp Ben. $ 1,000,00 B AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS BOP3719966 04/01/2018 W01/2019 COMBINED SINGLE LIMIT Ea accident $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ B X UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE BOP3719966 1 04/01/2018 04/01/2019 EACH OCCURRENCE $ 2,000,00 AGGREGATE $ 2,000,00 DED I X RETENTION $ 0 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR/PARTNER/EXECUTIVE � OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS balnw NIA 1951272 04/01/2018 04MI12019 X PER TH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYE $ 1,000,00 $ 1,000,00 E.L. DISEASE - POLICY LIMIT C Professional E0000037269-02 04/01/2018 04/01/2019 Ea Claim 2,000,000 ,Aggregate 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Fort Collins is named additional insured with regards to general liability. I;tK I IFII;A It NULUtK I;ANUtLLA I IUN CITYFT5 City of Fort Collins Purchasing Division PO Box 580 Fort Collins, CO 80522 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 ALM2S-1 PAGE 2 NOTEPAD INSURED'S NAME alm2s OP ID: P5 Date 03/21/2018 When required by written contract the following applies: Blanket Additional Insured BP 0451 Primary and Non -Contributory BP 1488 Blanket Waiver of Subrogation BP 0497 Additional Insured - State or Governmental Agency or Subdivision or Political Subdivision - Permits or Authorization Relating to Premises BP 0407 Blanket Additional Insured - Owners. Lessees or Contractors with Additional Insured Requirements for Parties in Construction Contract - BP 0451 ile - Additional Insured CA 7078 Waiver of Subrogation CA 0444 rella - Following Form Compensation - Blanket Waiver of Subrogation 359-B