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HomeMy WebLinkAboutRESOURCE CENTRAL - INSURANCE CERTIFICATE (3)BOULD-4 OP ID: CT CERTIFICATE OF LIABILITY INSURANCE DATE(M12/07/20YYY) /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 Phone: 970-223-1804 NAMEACT Front Range Insurance Group PHONE FAx 2002 Caribou Drive, Ste. 101 Fax: A/c No Ext : _ (A/c, No): Fort Collins, CO 80525 E-MAIL Steven G. Smith ADDRESS: INSURED Jen Scroggins 2639 Spruce Street Boulder, CO 80302 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:CSU Producer Resources Inc 13037 INSURER6:Cincinnati Insurance Companies 10677 INSURER c : Pinnacol Assurance 41190 INSURER D : COVERAGES CERTIFICATE NUMBER: REVISION NUMRFR- 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. INt L TYPE OF INSURANCE DDL UBR POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD/YYYY LIMITS ERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence COMMERCIAL GENERAL LIABILITY X '.CS00072159 06/29/2017 06/29/2018 $ 100,000 MED EXP (Any one person) . CLAIMS -MADE XJ OCCUR $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY PRO- LOC $ — AUTOMOBILE LIABILITY Ea, ccid.nBINEDl) GLE LIMIT $ 1,000,00 BODILY INJURY (Per person) $ B X ANY AUTO X EPP0336347 06/29/2017 06/29/2018 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON-OWNED X HIRED AUTOS EXAUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 B X EXCESS LIAB CLAIMS -MADE X EPP0336347 OW2912017 W2912018 DED I X RETENTION$ 10,000 1 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY I ANY PROPRIETOR/PARTNER/EXECUTIVEY/N 3305579 10/01/2017 10/01/2018 X WC STATU- OTH- T RY LIMITS ER E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N/A E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPT!ON OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 B (Property IEPP0336347 06/29/2017 06/29/2018 BPP 224,998 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The insurance evidenced by this certificate will not reduce coverage or limits and will not be cancelled, except after 30 days written notice has been received by the City of Fort Collins. CERTIFICATE HOLDER CANCELLATION CITY-02 City of Fort Collins 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 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD