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HomeMy WebLinkAbout113275 ALM2S - INSURANCE CERTIFICATE (7)ALLER-3 OP ID: P5 ACORO° r ATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE TE(MM/ DIYY 017 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 K�iren E. Siwek, CPA _ Brown & Brown Inc PHONE 970-482-7747 a No : 970-484-4165 4532 Boardwalk Dr, Suite 200 ac No Ell: Fort Collins, CO 80525 ADDRESS: William S. Rich ksiwek@bbcolorado.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Plnnacol Assurance Company 41190 INSURED alm2s INSURER B: Westfield Insurance Company 24112 712 Whalers Way, Ste. B-100 INSURER C: Admiral Insurance Company 24856 Fort Collins, CO 80525 INSURER D : INSURER E INSURER F cnvGa?eaFc RFRTIFIRATF NI IMRFR• RFVISIt7N NI IMRFR- 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'SUB WV POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADEFXI OCCUR ENTED PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,00 _ X EBUEPL PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY PRO- JECT ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,00 Emp Ben. $ 1,000,00 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000 OO > BODILY INJURY (Per person) _ $ B X ANY AUTO X BOP3719966 04/01/2017 04/01/2018 BODILY INJURY (Per accident) ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS L $ per accident PER DAMAGE _ $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,00 AGGREGATE $ 2,000,00 B EXCESS LIAB CLAIMS -MADE BOP3719966 04/01/2017 04/01/2018 DED I X I RETENTION $ 0 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 1961272 04/01/2017 04/01/2018 X PER OTH- STATUTE ER E.L. EACH ACCIDENT _ __ $ 1,000,00 _E.L. DISEASE _-_E_AEMPLOYEE _ _ --- $ 1,000,00 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N / A If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Professional E0000037269-01 04/01/2017 04/01/2018'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) RE: Park Architectural Services On -Call City of Fort Collins, its officers, agents and employees shall be included as additional insured with respect to General Liability and Automobile Liability per policy forms and conditions on page 2. 30 Day Notice of Cancellation applies to General Liability and Automobile Liability. CITYFC2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE William S. Rich © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD � ALLER-3 PAGE 2 NOTEPAD INSUREDS NAME alm2s OP ID: P5 Date 04/04/2017 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 Automobile - Blanket Additional Insured CA 0778 Blanket Waiver of Subrogation CA 0444 Umbrella - Following Form Workers Compensation - Blanket Waiver of Subrogation 359-B i