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HomeMy WebLinkAbout309311 CAPSTONE INC - INSURANCE CERTIFICATE (5)1 ® A� o CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY) 1/11/2018 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 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 CONTACTNAME: Ellie Jeffers H NNuExt (303) 442-1484 FAAX No): (so3)442-8822 Taggart and Associates, Inc E-MAIL ADDRESS: ellie'@tagg artinsurance.com 1680 38th Street, Suite 110 INSURERS AFFORDING COVERAGE NAIC # P . 0. Box 147 A:Libert Mutual Insurance Company Boulder CO 80306 --INSURER INSURED INSURERS Allied World Surplus Lines 24319 INSURERC: Capstone, Inc. INSURERD: 11001 W. 120th Ave, Suite 220 INSURL Broomfield CO 80021 INSUR COVERAGES CERTIFICATE NUMBER:18-19 Master 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 UBR POLICY NUMBER PM/D OLICY EFF MM/ ICY EXP LIMITS LTR1= lam X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE X❑ OCCUR PREMISES Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ 15,000 X BZS57655994 1/6/2018 1/6/2019 PERSONAL & ADV INJURY $ Excluded GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PECOT- LOC PRODUCTS-COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 $ A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BZS57655994 1/6/2016 1/6/2019 BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PPReOa RidT DAMAGE a NON -OWNED HIRED AUTOS AUTOS X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 8,000,000 AGGREGATE $ 8,000,000 A EXCESS LIAB CLAIMS MADE DED X I RETENTION$ 10,000 g US057655994 1/6/2018 1/6/2019 WORKERS COMPENSATIONPER AND EMPLOYERS' LIABILITY Y I N STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) NIA XwS57655994 1/6/2018 1/6/2019 E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 N yes , describe under DESCRIPTION OF OPERATIONS below l ! E.L. DISEASC - POLICY LIMIT I $ 1,000,000 B Network Security 03067192 6/2/2017 6/2/2018 Limit $1,000,000 Retention $2 , 500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins is included as additional insured to the General Liability coverage as required by written contract. A 30 day notice of cancellaton will be provided to the certificate holder. CERTIFICATE HOLDER City of Fort Collins PO Box 580 Fort Collins, CO 80522-0580 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 lie Jeffers/AHS ACORD 25 (2014/01) INS025 (201401) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD