Loading...
HomeMy WebLinkAbout109005 POUDRE VALLEY AIR OF NORTHERN COLORADO - INSURANCE CERTIFICATE (7)DATE (MM/DDNYYY) A� " CERTIFICATE OF LIABILITY INSURANCE 10/13/2017 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: Dana Stewart, CIC, CISR Flood and Peterson PHONN (970)266-7149No:(970)506-6845 PO Box 578 ADDRESS: DStewartQfloodpeterson.com INSURER/81 AFFORDING COVERAGE NAIC M Greeley CO 80632 INSURER A:Employers Mutual Casualty Company 21415 INSURED INSURERB:Pinnacol Assurance _ 41190 Poudre Valley Air Of Northern INSURERC: Colorado, Inc INSURERD: 2416 Donella Court, Suite A INSURERE: Fort Collins CO 80524 INSURERF: CnVFRAr:FS CFRTIFICOTF NIIMRER-GL/AU/XS x10/18 WC x7/18 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 TYPE OF INSURANCE DL S BR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR X I COMMERCIAL GENERAL LIABILr1Y EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE Fil OCCUR $ 500,000 DAMAGE T PREMISES EaENTED occurrence IVIED EXP (Any one person) SX77586 10/17/2017 10/17/2018 $ 10,000 PERSONAL 8 ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 JECT 0 LOC PRODUCTS - COMP/OPAGG $ 2,000,000 PPOLICY $ OTHER: AUTOMOBILE LIABILITY MINED SINGLE LIMIT Ea accident $ 11000,000 BODILY INJURY (Per person) $ A X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS x NON -OWNED AUTOS SX77586 10/17/2017 10/17/2018 BODILY INJURY (Per accident) $ PROPPEE TideDAMAGE (PerX $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 PIDED AGGREGATE $ 3,000,000 A EXCESS LIAB CLAIMS -MADE I x I RETENTION$ 0 $ 5X77586 10/17/2017 10/17/2018 WORKERS COMPENSATION LIABILITY AND EMPLOYERS' Y ANY PROPRIETOR/PARTNER/EXECUTIVE X PER H- STATUTE ER E.L. EACH ACCIDENT $ 11000,000 E.L. DISEASE - EA EMPLOYEd $ 1,000,000 OFFICER/MEMBER13 EXCLUDED? ❑ (Mandatory in NH) NSA 4074340 7/1/2017 7/1/2018 E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) GERTIFIGAI E HULUEH GANt tLLA I IUN City of Fort Collins Home Efficiency Program PO 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 Stewart, CIC, CISR/ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 r ol4on