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HomeMy WebLinkAbout563449 CENTERLINE SOLUTIONS LLC - INSURANCE CERTIFICATE (5)AGUHL), CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 2/1/2019 1 /24/2018 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER Lockton Companies 8110 E. Union Avenue Suite 700 Denver CO 80237 NAMECONTACT: PHONE A/C No Ext : FANo): E-MAIL ADDRESS: INSURER AFFORDING COVERAGE NAIC # (303) 414-6000 INSURER A : Zurich American Insurance Company 16535 INSURED Centerline Solutions, LLC 1408175 16035 Table Mountain Parkway Golden, CO 80403 INSURER B : Endurance American Insurance Company 10641 INSURER C : Berkley Assurance Company 39462 INSURER D : INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 13704011 RFVI1RION Milil R• XXXXXXX 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 INSD SUER WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y N GLA02321 1902 2/1/2018 2/1/2019 EACH OCCURRENCE 1,000,000 CLAIMS -MADE � OCCUR PREMISETO S (Ea RENTED ) $ 1,000,000 X MED EXP (Any oneperson) 10,000 Contractual Liab X XCU PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. POLICY 7X JECOT- ❑ LOC GENERAL AGGREGATE $ 2,000 000 PRODUCTS - COMP/OP AGG $ 21000,000 1 $ OTHER: A AUTOMOBILE LIABILITY Y N GLA023211902 2/1/2018 2/1/2019 COMBINED SINGLE LIMIT Ea accident $ 2,000,000 X BODILY INJURY (Per person) $ XXXXXXX ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident $ XXXXXXX AUTOS ONLY AUUTO ONLY WNED Peer accidentRTY DAMAGE $ XXXXXXX $XXXXXXX B X UMBRELLA LIAB X OCCUR N N EXC30000049902 2/1/2018 2/l/2019 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ $ XXXXXXX A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANYOFFICER MEMBOER/ EXCLUDED? ECUTIVE N❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A N WCO23211702 2/1/2018 2/1/2019 I TH- X STATUTE OER EL EACH ACCIDENT $ 1,000,000 E L DISEASE - EA EMPLOYEE 1,000,000 E L DISEASE POLICY LIMIT 1,000,000 A Inst Floater, Leased/Rented Equip N N CPP023212502 2/1/2018 2/1/2019 Sim. S250K/item C Prof/PolUCyb PCADB50014410218 2/1/2018 2/1/2019 $5M/cim prf; $5M/cim pol; $12M agg; Cyber $2M DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) fhe City of Port Collins, its officers, agents and employees are included as Additional insured as respects General Liability and Automobile Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 13704033 AUTHORIZED REPRESENTATIVE City of Fort Collins PO Box 580 Fort Collins CO 80522 ACORD 25 (2016/03) ©1 R812015 ACORD CORPO ATION. All rights reserved The ACORD name and logo are registered marks of ACORD