Loading...
HomeMy WebLinkAbout501351 WORKSPACE INNOVATIONS LLC - INSURANCE CERTIFICATE (3)ACC) ® DATE (MM/DD/YYYY) V CERTIFICATE OF LIABILITY INSURANCE 1/30/2017 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 CONTACT CathyBaker NAME: Moody Insurance Agency, Inc. PHONE 9 ExU: (303) 824-6600 � No: (303)370-0118 8055 East Tufts Avenue E-MAIL-ADDRESS: y' y Cath baker@mood ins.com Suite 1000 INSURERS AFFORDING COVERAGE NAIC # Denver CO 80237 INSURERA:Union Insurance Co 25844 INSURED INSURER B :Pinnacol Assurance 41190 Workspace Innovations, LLC 4414 E. Harmony Road #100 D: J Fort Collins CO 80528 1 INSURERF: COVERAGES CERTIFICATE NUMBER:16-17 PRG/ 17-18 WC 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 REOUIREN4ENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH REST ECT 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/DDYYY IY POLICY EXP MM/DD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 300 , 000 MED EXP (Any one person) $ 10,000 X CPA 3070334-24 9/1/2016 9/1/2017 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- X _ JECT LOG PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1, O00 , 000 BODILY INJURY (Per person) $ A X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS X CPA 3070334-24 9/1/2016 9/1/2017 BODILY INJURY (Per accident) $ $ PROPERTY DAMAGE Per accident X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4,000,000 AGGR_ EGATE _ $ 41,000,000 A EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ CPA 3070334-24 9/1/2016 9/1/2017 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E (Mandatory in NH) N / A 4129130 2/1/2017 2/1/2018 g STATUTE I ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEd $ 1,000,000 E.L. DISEASE - POLICY LIMIT If Yes, describe under DESCRIPTION OF OPERATIONS below 1 $ 1 000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CFRTIFICATE HOLDER CANCELLATION City of Fort Collins Attn: Jennifer Harvey 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 Cathy Baker/RYAMAR < t � ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)