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HomeMy WebLinkAbout565922 AU WORKSHOP LLC - INSURANCE CERTIFICATE (9)Client#: 1090168 AUWORLLC ACORD.. CERTIFICATE OF LIABILITY INSURANCE DATE 19/20/Y 12/9I206 16 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 g00 873-8500 AIC, No, Ext : A/C, No): P.O. Box 7050 E-MAIL ADDRESS: Englewood, CO 80155 INSURER(S) AFFORDING COVERAGE NAIC # 800 873-8500 INSURER A: Sentinel Insurance Company Ltd. 11000 INSURED Hartford Ins Co of the Midwest 37478 [au]workshop, Ilc 405 Linden St Fort Collins, CO 80524 INSURER B : INSURER c : XL Specialty Insurance Company 37885 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NLIMRFR- PFVISInM NI IMRI=P- 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 ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY 11/01/2016 POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR Y Y 34SBWPP2901 11/01/2017 EACHOCCURRENCE $1,000,000 _ $1,000,000 PREMISES ERENTED Eoccccu ence MED EXP (Any one person) $10,000 l _ PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY X JECT I__ LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 1 $ OTHER: A AUTOMOBILE LIABILITY Y Y 34SBWPP2901 1/01/2016 11/01/201 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS BODILY INJURY (Per er accent ( ) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Par accident $ $ A X UMBRELLA LIAB X OCCUR Y Y 34SBWPP2901 11/01/2016 11/01/2017 EACH OCCURRENCE $1000000 AGGREGATE $1,000,000 EXCESS LIAB CLAIMS -MADE DED I X I RETENTION $1 O 000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE— OFFICER/MEMBER EXCLUDED? ` Y N / A Y 34WECAA0595 3/08/2016 03108/2017 X PER OTH- E.L. EACH ACCIDENT $100000 - E.L. DISEASE - EA EMPLOYEE (Mandatory in NH) $100,000 If yes, describe under DESCRIPTION OF OPERATIONS below_ E.L. DISEASE - POLICY LIMIT $500,000 C Professional DPR9803528 4/12/2016 04/1212011 $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) t.tK I It-It.A I t nULutK GANGtLLA I IUN City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 300 Laporte Ave ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins, CO 80524 AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) 1 of 2 The ACORD name and logo are registered marks of ACORD #S19476308/M19378072 SQSZP DESCRIPTIONS (Continued from Page 1) The General Liability, Automobile Liability, Umbrella/Excess insurance applies on a primary and non contributory basis. A Blanket Waiver of Subrogation applies for General Liability, Automobile Liability, Umbrella/Excess Liability and Workers Compensation. The Umbrella / Excess Liability policy provides excess coverage over the General Liability, Automobile Liability and Employers Liability. Please note that Additional Insured status does not apply to Professional Liability or Workers' Compensation. ** Workers Comp Information ** Proprietors/Partners/Executive Officers/Members Excluded: KERSLEYJASON,ELECOFC SHORTRIDGE RANDY, ELECOFC SAGITTA 25.3 (2014/01) 2 of 2 #S19476308/M19378072