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HomeMy WebLinkAbout565922 AU WORKSHOP LLC - INSURANCE CERTIFICATE (8)Client#: 1090168 AUWORLLC ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 1 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 USI Colorado, LLC Prof Liab P.O. Box 7050 Englewood, CO 80155 800 873-8500 CONTACT NAME: PHONE g00 873-8500FAX AIC No Ext : A/C, No): EMAIL ADDRESS:-_- _-- INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Sentinel Insurance Company Ltd. 11000 INSURED [au]workshop, Ilc 405 Linden St INSURER B : Hartford Ins Co of the Midwest 37478 XL Specialty Insurance Company INSURER C : P tY p Y 37885 Fort Collins, CO 80524 INSURER D : INSURER E INSURER F : 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 Y SUBR WVD Y POLICY NUMBER 34SBWPP2901 POLICY EFF (MMIDD POLICY EXP MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY 11/01/2016 11/01/2017 EACHOCCURRENCE$1,000,000 CLAIMS -MADE � OCCUR PREMISES Eaoccu RENTED $1,000,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: RC - POLICY � JET F LOC GENERAL AGGREGATE I $ 2,000,000 PRODUCTS - COMP/OPAGG $2,000,000 $ OTHER: A AUTOMOBILE LIABILITY Y Y 34SBWPP2901 1/01/2016 11/01/2017 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS XI BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ A X' UMBRELLA LIAB X OCCUR Y Y 34SBWPP2901 11/01/2016 11/01/2017 EACH OCCURRENCE $1 000 000 AGGREGATE $1 000 000 EXCESS LIAB CLAIMS -MADE DED I X, RETENTION $1 O 000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICERIMEMBER EXCLUDED? Fy—] (Mandatory in NH) yes, describe under DESCRIPTION OF OPERATIONS below N / A Y 34WECAA0595 03/08/2017 03/0812018 X IPER OTH- STATUTE ER E.L. EACH ACCIDENT $100000 E.L. DISEASE - EA EMPLOYEE $100,000 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 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 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) (:tK I IFIC:A 1 t HULUtK UANL;tLLA I IUN City of Fort Collins 300 Laporte Ave Fort Collins, CO 80524 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 #S20239656/M20238527 ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MDKZP