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HomeMy WebLinkAbout565922 AU WORKSHOP LLC - INSURANCE CERTIFICATE (7)Client#: 1090168 AUWORLLC ACORD- CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 4/04/2017 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 NAME: USI Colorado, LLC Prof Liab PHONE 800 873-8500 FAX A/C, No, Ex,): (A/C, No)_: P.O. Box 7050 E-MAIL Englewood, CO 80155 ADDRESS 800 873-8500 INSURER(S) AFFORDING COVERAGE NAIC # S II INSURED [au]workshop, Ilc 405 Linden St Fort Collins, CO 80524 INSURERA: entlne nsurance Company Ltd. 11000 INSURER B : Hartford Ins Co of the Midwest 37478 INSURERC: XL Specialty Insurance Company 37885 INSURER D : INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMRFR- 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 SUBRI WVD _ POLICY NUMBER POLICY EFF (MM.1DDrYYYy]L_ I POLICY EXP MM1DDNYYY) LIMITS Y Y .. EACH OCCURRENCE A X COMMERCIAL GENERAL LIABILITY 34SBWPP2901 11/0112016111/0112017 $1,000,000 CLAIMS -MADE l ^I OCCUR $1,000,000 PREMISES Eaoecu RENTED MED EXP (Any one person) $10,000 _ PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE E LIMIT APPLIES PER: POLICY ^JECOT LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $2,000,000 $ OTHER: A AUTOMOBILE LIABILITY Y Y 34SBWPP2901 11/0112016111/011201 COMBINED SINGLE LIMIT Ea accident $1,000,000 _ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X NON -OWNED AUTOS $ PROPERTY DAMAGE Per accident A XI UMBRELLA LIAB X OCCUR Y Y 34SBWPP2901 1110112016 11/01/2017 EACH OCCURRENCE $1,000,000 _ AGGREGATE EXCESS LIAB CLAIMS -MADE $1,000,000 DED X' RETENTION $1 O 000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N OFFICER/MEMBER EXCLUDED? � N / A Y 34WECAA0595 3/08/2017 03/08/201 X PER OTH- E.L. EACH ACCIDENT $100000 E.L. DISEASE - EA EMPLOYEE $100000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below _ _ E.L. DISEASE - POLICY LIMIT $500,000 C Professional _ _ DPR9912889 _ 4/12/2017 04/12/2018 $1,000,000 per claim Liability $1,000,000 annl aggr. Claims Made DESCRIPTION OF OPERATIONS / 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 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) 173i711IiLWL•Ll7 i LAA A MIR ill City of Fort Collins PO 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 \C ACORD 25 (2014/01) 1 of 2 #S20239655/M20238527 ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MDKZP