HomeMy WebLinkAboutSTRUCTURE INC - INSURANCE CERTIFICATE (2)DATE (MMlDD/YWY)
AC"RV ® CERTIFICATE OF LIABILITY INSURANCE
12/20/2017
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 Jen Ianelli
NAME:
Moody Insurance Agency, Inc. PAHLON�F�st1 (303) 824-6600 � No: (303)370-0118
8055 East Tufts Avenue E-MAIL ADDRESS: y en.ianelli@mood ins.com
Suite 1000 INSURERS AFFORDING COVERAGE NAIC #
Denver CO 80237 INSURERA:Travelers Prop Cas Co of America 25674
INSURED INSURER B :Standard Fire Insurance Co 19070
Structures, Inc. INSURER C :
4 Inverness Ct E Ste 250 INSURERD:
INSURER E :
J Englewood CO 80112 I INSURER F :
rOVFRAAFS CFRTIFICATF NUMRFR-17-18 w/Forms 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 ADDL SUER POLICY NUMBER POLICY EFF MMLIDI EXY LIMITS
LTR
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
CLAIMS -MADE ❑X OCCUR
ED
PREMISES Ea oc urrence
$ 300,000
R
MED EXP (Any one person)
$ 5,000
AI Form CGD246 (08/05)
X
DTC0324D8411TIL17
12/31/2017
12/31/2018
PERSONAL 8 ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
POLICY ] JPERCOT LOC
$
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea ccident
a
$ 1,000,000
BODILY INJURY (Per person)
$
A
X ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
DT810324DB411TIL17
12/31/2017
12/31/2018
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
NON --OWNED
HIRED AUTOS AUTOS
X
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 5,000,000
A
EXCESS LIAB
CLAIMS -MADE
DED I X I RETENTION$ 10,000
$
CUP4K5298BA1726
12/31/2017
12/31/2018
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
YIN ANY PROPRIETOR/PARTNER/EXECUTIVE
X PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,000
B
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
N / A
UB7J03575A1826
1/1/2018
1/1/2019
E.L. DISEASE - EA EMPLOYE
$ 1 0901900
E.L. DISEASE -POLICY LIMIT
1 $ 1 000,000
If yes. describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Re: 7338 Troutman Court East #250
City of Fort Collins and State of Colorado are named as an additional insured with respect to General
Liability.
CERTIFICATE HOLDER C;ANL:tLLA I IUN
City of Fort Collins
Financial Services Purchasing Division
215 N Mason St, 2nd floor
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
Jen Ianelli/AMAHRO —--—�__
U 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
INS025 (201401)