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HomeMy WebLinkAboutLARIMER COUNTY - INSURANCE CERTIFICATEACQRL�0 C" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) F5/23/2017 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 Arthur J. Gallagher Risk Management Services, Inc. 6300 South Syracuse Way, Suite 700 Centennial CO 80111 TACT NAME: Anita Bruner ^— PHONE FAX CANoti Ex: 303 889 2574 303-889-2575 ADDRESS, anita_bruner@ajg.com INSURERS AFFORDING COVERAGE NAIC # INSURERA:Argonaut Insurance COmpan 19801 INSURED INSURERB: INSURER C : Larimer County, Colorado 200 W. Oak Street --"— Suite 4000 INSURER D : _ Fort Collins CO 80522 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 629105024 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 LTR TYPE OF INSURANCE I S WV POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y 290201902 5/15/2017 5/15/2018 EACH OCCURRENCE $1,000,000 if -WD CLAIMS -MADE L J OCCUR PREM SES Ea ocOREcu rrence E X MED EXP (Any one person) $ SIR: $500,000 X Per Occ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $1,000,000 POLICY C PRO ❑ LOC JECT X PRODUCTS - COMP/OP AGG $ $ OTHER: A AUTOMOBILE LIABILITY 290201902 5/15/2017 5/15/2018 COMBINED INGLE LIMIT Ea accident $1,000,000 X _ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY BODILY INJURY (Per accident) $ IZOPAMAGE— Per accident) $ X $ SIR $,00,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE _ $ EXCESS LIAB CLAIMS -MADE DIED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y /N ANY PROPRIETOR/PARTNER/EXECUI— ❑ OFFICER/MEMBER EXCLUDED? N/A STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below -- E.L. DISEASE - POLICY LIMIT --" $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Fort Collins is Additional Insured as respects General Liability policy, pursuant to and subject to the policy's terms, definitions, conditions and exclusions. RE: Revocable Permit for Access on City property, Front Range Trail project on Flores Del Sol Natural Area Dates: March 1, 2017 through February 28, 2018 Location: Exhibit A - The N1/2 of the SE 1/4 of Section 19, Township 6 North, Range 68 West of the 6th P.M., County of Larimer, State of Colorado. Execpting therefrom that part conveyed to the Board of County Commissioners in Deed of Dedication recorded May 4, 1994 at Reception No. 94039129. (Vacant land, no street address assigned.) L;LK 1 IF II;A I t HULUtK UANL;LLLA I IVN City of Fort Collins, Risk Management PO Box 580 Fort Collins CO 80522-0580 USA 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 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD