HomeMy WebLinkAboutLARIMER COUNTY - INSURANCE CERTIFICATE (2)1 ® DATE (MMIDDNYYY)
,4`oRo CERTIFICATE OF LIABILITY INSURANCE
11612017
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 endorsements .
PRODUCER NAME: Anita Bruner _
Arthur J. Gallagher Risk Management Services, Inc. ONE 303 889 2574 FAX
PH303-889 2575
6300 South Syracuse Way, Suite 700 E-MAIL
Centennial CO 80111 anita_bruner@a com
AD>2R J9'
INSURED
Larimer County, Colorado
200 W. Oak Street
Suite 4000
Fort Collins CO 80522
A:ArgonautInsurance C
C:
E:
-I ncn-ti 0al)o Drtncinttl ful IM91170-
9801
THIS IS TO CERTIFY THAT THE POLICIESOFINSURANCE 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 B POLICY EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE NSD WVD POLICY NUMBER MMIDDNYYY MIWDDNY
A
X
COMMERCIAL GENERAL LIABILITY
Y
290201901
5/15/2016
5/15/2017
EACH OCCURRENCE
$1,000,000
PREMISES Ea occurrence
$
CLAIMS -MADE ^ OCCUR
X
MED EXP (An one person)
$
SIR: $500000
X
Per Occ
PERSONAL & ADV INJURY
$
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$1,000,000
PRODUCTS . COMP/OP AGG
$
PROJECT LOC
X POLICY 7
E
OTHER:
A
AUTOMOBILE LIABILITY
290201901
5/15/2016
5115/2017
COMBINED SINGLE LIMIT
(Ea accident
E1,000,000
X ANY AUTO
BODILY INJURY (Per person)
E
BODILY INJURY (Per accident)
$
H p
ALL OWNED AUTOSULED
NON -OWNED
HIRED AUTOS AUTOS
Per accident
E
E
X SIR $500,000
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
E
AGGREGATE
E
EXCESS LIAB
CLAIMS -MADE
DIED I I RETENTION E
H
I PR _
$
WORKERS COMPENSATION
STATUTE ER
E.L. EACH ACCIDENT
AND EMPLOYERS' LIABILITY Y / N
E _
ANY PROPRIETOR/PARTNER/EXECUTIVE
N/A
E.L. DISEASE - EA EMPLOYE
$
OFFICER/MEMBER EXCLUDED? ❑
(Mandatory in NH)
E.L. DISEASE -POLICY LIMIT
If yes, describe under
DESCRIPTION OF OPERATIONS below
E
i
I
DESCRIPTION OF OPERATIONS I LOCATIONS I 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
See Attached...
,+CAT1L1/1ATt Uni nC'D CANCFLLATION
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 PRESENTATIVE
'� 1`Jtf2S-LU19 {iI..VKU I..VKI"vrtM11v 1r. r+n 11yn�a lcacr vcu
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID:
LOC #:
R ADDITIONAL REMARKS SCHEDULE
Page 1 of 1
AGENCY
NAMEDINSURED
Arthur J. Gallagher Risk Management Services, Inc.
Larimer County, Colorado
200 W. Oak Street
Suite 4000
POLICY NUMBER
Fort Collins CO 80522
CARRIER
NAIC CODE
EFFECTIVE DATE:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: _25FORMTITLE: CERTIFICATE OF LIABILITYINSURANCE
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.)
ACORD 101 (2008/01) ® 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD