HomeMy WebLinkAboutTEAMMATES COMMERCIAL INTERIORS - INSURANCE CERTIFICATE (3)AC"RDF
1..�. CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
F9/29/2017
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 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 endorsements .
PRODUCER
Commercial Risk Solutions
6600 E Hampden Ave Ste 200AC
Denver CO 80224
CONTACT
NAME: Valerie Brown _
PHONE FAX
No �)• 303 996-7847 _ C, Nof: 303-757-7719
ADDRES_s: IL vbrown@crsdenver.com
INSURER(S) AFFORDING COVERAGE NAIC #
INSURERA:Westfleld Insurance_ _
24112
INSURED TEAMM-1
INSURER B : Pinnacol Assurance _
41190
Teammates Commercial Interiors
320 S Teller Street, Suite 250
Lakewood CO 80226-3237
INSURERC:
INSURER
— - - ---
INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBER: 98671104 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 ADVIL TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS
LTR INSD WVD POLICY NUMBER MWDD/YYY MM/DD/YYYY
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE X❑ OCCUR
Y
CWP3177709 10/1/2017
10/112018
EACH OCCURRENCE_
$1,000,000
-DAMAGE TO
PREM SES1EaEoccu rents
$500,000
ME EXP (Anyone person)
$5,000
PERSONAL & ADV INJURY
$1,000,000
_
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY jE LOC
OTHER:
GENERAL AGGREGATE
b2,000,000
PRODUCTS - COMPIOP AGG
$ 2,000,000
$
A
AUTOMOBILE
LIAE31LITY
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNER
AUTOS ONLY X AUTOS ONLY
Y
CWP3177709
10/1/2017
10/1/2018
COMBINED SINGLE LIMIT ----
Ea accident
$1,000,000
X
BODILY INJURY (Per person)
$
x
BODILY INJURY (Per accident)
$
Pe_r accidej __—
$
$
A
X
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
CWP3177709
10/1/2017
10/1/2018
EACH OCCURRENCE
$5,000,000
!X]
AGGREGATE
$5,000,000
DIEDx RETENTION$0 r
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
ityes, describe under
DESCRIPTION OF OPERATIONS below
N/A
4062360
10/1/2017
10/1/2018
X STATUTE ER
.
$500,000
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
_--
$500,000
$500,000
—
E.L. DISEASE - POLICY LIMIT
I
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
Re: 8026 Furniture for New Utilities Administration Building. The City of Fort Collins, its officers, agents and employees are included as
additional insured for ongoing operations on the General Liability and included as additional insured on the Auto Liability with respect to
operations of the named insured for the certificate holder as required by written contract. All policy terms, conditions and exclusions apply.
L;tH 1 II-IL;A I t HULUtH L:ANL;tLLA I IUN
City of Fort Collins Financial Services Purchasing
Devision
P.O. 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
cV 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD