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HomeMy WebLinkAbout210929 SCOTCH PINES VILLAGE LLLP - INSURANCE CERTIFICATESCOTC-2 OP ID: P5 ACORO- r ATE (MM/DD/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE TE(MMI DfYY 017 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 CONTANAME: Karen E. Siwek, CPA Brown & Brown Inc PHONE - - -- FAX - - 4532 Boardwalk Dr, Suite 200 AUC No E>c:970-482-7747 A/c No): 970-484-4165 Fort Collins, CO 80525 E-MAIL Karen E. Siwek, CPA -ADDRESS: ksiwek@bbcolorado.com INSUREII AFFORDING COVERAGE NAIC # INSURER A: Westfield Insurance Company 24112 INSURED Scotch Pines Village, LLLP INSURERB: C/o Sitzman-Mitchell 8r Co 3500 JFK Pkwy, Ste 220 INSURERC: Fort Collins, CO 80525 INSURERD: INSURER E: _ INSURER F : COVERAGES CERTIFICATE NUMBER: 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 LTR INPOLICY SD UBRI POLICY NUMBER EFF MM/ D1YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,00 CLAIMS -MADE AIOCCUR X CWP0911344 01/01/2017 01/01/2018 DAMAGE TO RENTED PREMISES Ea occurrence $ 500,00 MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,00 POLICY F--1PRO- r 1 JECT LI LOC PRODUCTS -COMP/OP AGG $ 4,000,00 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ 1,000,00 A ANY AUTO CWP0911344 01/01/2017 01/01/2018 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 4,000,00 AGGREGATE A EXCESS LIAB CLAIMS -MADE CWP0911344 01/01/2017 01/01/2018 $ 4,000,00 DED I X RETENTION $ 0 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE PER OTH- STATUTE I ER E.L. EACH ACCIDENT $ OFFICFR/MFMRER EXCLUDED? ❑ N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins is included as Addtional Insured (CG7118 11/12) Any insurance policy required herein shall provide, by endorsement to the policy, that FCU shall not by reason of its inclusion as an additional Insured incur liability to the insurance carrier for the payment of premium of such insurance CITYF11 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. P O Box 550 Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE Karen E. Siwek, CPA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD