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HomeMy WebLinkAbout102925 MOUNTAIN STATES EMPLOYERS COUNCIL - INSURANCE CERTIFICATECI ient#: 1084940 MOU NTSTA15 DATE (MM/DD/YYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 17/13/2018 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 have ADDITIONAL INSURED provisions or 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: USI Colorado, LLC Prof Liab PHONE 800 873-8500 FA A/C No Ext : A/CX , No P.O. Box 7050 E-MAIL ADDRESS: _ Englewood, CO 80155 INSURER(S) AFFORDING COVERAGE NAIC # 800 873-8500 INSURER AraveTler Indemnity Company of CT 25682 INSURED INSURER B : Traveler: Indemnity Company 25658 Mountain States Employers Council, Inc. dba Employers Council Services, Inc. 1799 Pennsylvania St. Denver, CO 80203 f'n11=0A!2_CC r`CRTICIr`ATF NIIMRFR- INSURER C : Pinnecol Assurance Company 41190 INSURER D : Indian Harbor Insurance Company 36940 INSURER E INSURER F : RFVIRION NIIMRFR' 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 CONTRACTOR 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 INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS A XI COMMERCIAL GENERAL LIABILITY X X 6809E4474551842 7/15/2018 07/15/201 EACHOCCURRENCE $1,000,000 —CLAIMS -MADE EX]OCCURPREMISES Eaoccurrence $300,000 IT MED EXP (Any one person) s5,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO. x � POLICY JECT LOC PRODUCTS - COMP/OP AGG $2,000,000 $ OTHER: _ B AUTOMOBILE LIABILITY X X BA9E45007818SEL 07115120111 07/15/201 BINED Ea acccd.n SINGLE LIMIT 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED X'� AUTOS ONLY X AUTOS ONLY PROPERTY DAMAGE Per accident $ - — $ XI B X UMBRELLA LIAB X OCCUR x CUP9E4505151742 7/15/2018 07115/2019 EACH OCCURRENCE s8,000,000 AGGREGATE $$ 00O 000 EXCESS LUAB CLAIMS -MADE DED I X RETENTION $10000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE - / N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A x 4046690 7/01/2018 07/01/201 X PER OTH- TuTE ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below D Professional MPP004161005 7/1512018I07/15/201 Each Claim: 3,000,000 Liability Aggregate: 5,000,000 Claims Made Ded. Per Claim 50,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) If required by written contract or written agreement, the following provisions apply subject to the policy terms, conditions, limitations and exclusions: The Certificate Holder is included as Automatic Additional Insured's for ongoing and completed operations under General Liability; Designated Insured under Automobile Liability; and Additional Insured under Umbrella / Excess Liability but only with respect to liability arising out of the Named Insureds work performed on behalf of the certificate holder. This insurance (See Attached Descriptions) nvLUCIM Vl,l\ V LLLM 1 1- CI of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Gerry Paul; Purchasing Dept. ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 580 Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S23516222/M23512849 PVRZP No Text