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HomeMy WebLinkAbout565922 AU WORKSHOP LLC - INSURANCE CERTIFICATE (10)Client#: 1090168 AUWORLLC ACORD- CERTIFICATE OF LIABILITY INSURANCE DATED/YYYY) 12121 21/2/2017 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 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 FAX A/C No Ext : A/C No): P.O. Box 7050 ADDRI Englewood, CO 80155 ESS: BOO 573-8500 INSURER(S) AFFORDING COVERAGE NAIC 0 INSURER A' sentinel Insurance Company Ltd. 11000 INSURED Hartford Ins Co of the Midwest 37478 [au]workshop, IIC INSURERS' 405 Linden St Fort Collins, CO 80524 INSURER C : XL speclaay Insurance Company 37885 INSURER D INSURER E : COVERAGES CFRTIFICATF NIIMRFR• RFVISInm NI IMRFI7• 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 POLIC MM/DDY EFF POLICY EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR Y Y 34SBWPP2901 11/01/2017 11/01/2018 EACH OCCURRENCE $1,000,000 AM AGE TO RENTED PREMISES Ea occurrence $1 OOO OOO MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER, POLICY ECOT F7 LOG GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 $ OTHER: A AUTOMOBILE LIABILITY Y Y 34SBWPP2901 1/01/2017 11/01/201 COMBINEDSINGLELIMIT Ea accident $1,000,000 BODILY INJURY (Per person) $ ANY AUTO IXAUTOS OWNED AUTOS ONLY SCHEDULED AUTOS BODILY INJURY (Per accident) $ ONLY NON -OWNED AUTOS ONLY PROPERTYDAMAGE$ Per accident A X UMBRELLA LIAB X OCCUR Y Y 34SBWPP2901 1/01/2017 11/01/2018 EACHOCCURRENCE $1000000 AGGREGATE $1,000,000 EXCESS LIAB CLAIMS -MADE DED X RETENTION $10000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? NIA Y 34WECAA0595 3/08/2017 03/08/201 X PER OTH- E.L. EACH ACCIDENT $100 000 E.L. DISEASE - EA EMPLOYEE $100,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $500,000 C Professional DPR9912889 4/12/2017 04/12/2018 $1,000,000 per claim Liability Claims Made $1,000,000 annl aggr. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) As required by written contract or written agreement, the following provisions apply subject to the policy terms, conditions, limitations and exclusions: The Certificate Holder and owner are included as Automatic Additional Insured's for ongoing and completed operations under General Liability; Designated Insured under Automobile Liability; and Additional Insureds under Umbrella / Excess Liability but only with respect to liability arising out of the Named Insured work performed on behalf of the certificate holder and owner. (See Attached Descriptions) Ln__tCu1e![laZ7I 7i011111 91Ail City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 580 ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins, CO 80522-0580 AUTHORIZED REPRESENTATIV UTHORIZEDREPRESENTATIV E ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S22150765/M22148086 RTSZP