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HomeMy WebLinkAbout590416 SQUIRE PATTON BOGGS LLP - INSURANCE CERTIFICATE (3)ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/30/2016 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 INSURERS), 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: Marsh USA Inc. PHONE 216.937,1700 C. No. Ext) I tA/C. No): 200 Public Square E-MAIL ADDRESS: Suite 1000 Cleveland, OH 44114 INSURERS AFFORDING COVERAGE NAIC # _ INSURER A: National Union Fire Insurance Co. of Pittsburgh, PA 19445 J39088--Cas-16-17 INSURED INSURER B : Insurance Company Of The State Of PA 19429 SQUIRE PATTON BOGGS (US) LLP INSURER C : Commerce And Industry Ins Co 19410 SQUIRE PATTON BOGGS (UK) LLP INSURER D : NIA N/A ADMINISTRATIVE CENTER 1500 WEST 3RD STREET, STE 450 INSURER E : New Hampshire Insurance Company 123841 CLEVELAND, OH 44113-1408 INSURER F COVERAGES CERTIFICATE NUMBER: CLE-004416754-07 REVISION NUMBER:1 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 ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS E X COMMERCIAL GENERAL LIABILITY GL 2846270 12/31/2016 12/31/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE [❑ OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 1-1 PRO- ❑ JECT LOC PRODUCTS - COMPlOP AGG $ 2,000,000 $ OTHER A AUTOMOBILE LIABILITY 3018303 12/31/2016 12/31/2017 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS Owned Comp/Coll: $500/$500 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS Hired Comp/Coll: $1,000/$1,000 _ C X UMBRELLA LIAB X OCCUR BE 024550429 12/31/2016 12/31/2017 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE DEC)X FRETENTION$10,000 $ B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YN ANY PROPRIETOR/PARTNER/EXECUTIVE N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA A WC 12852426 (ADS) WC 12852398 CA ( ) 12/31/2016 12/31/2016 12/31/2017 12/31/2017 X PER oTH- STATUTE ER E.L EACH ACCIDENT $ 1,000,000 E.L DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION The City of Fort Collins, Colorado, A Municipal Corporation P.O. 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 of Marsh USA Inc. Michael R. Jackisch #A,(� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD