HomeMy WebLinkAbout555745 AISILING INC - INSURANCE CERTIFICATE7 ® DATE (MM/DD/YYYY)
AR" CERTIFICATE OF LIABILITY INSURANCE
1 /23/2018
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 NAME: JASON D PERCHA
JASON D PERCHA (16746) PHONE FAX
1405 W 29TH STREET Arc No Ext : 970-669-1263 MC No): 970-669-1309
AIL
LOVELAND. CO 80538-0000 ApDRESS, JASON.PERCHA@COUNTRYFINANCIAL.COM
INSURER(S) AFFORDING COVERAGE NAIC X
INSURER A: COUNTRY Mutual Insurance Company 20990
INSURED 5537622 INSURERS:
AISLING INC INSURERC:
1827 E MULBERRY ST
FORT COLLINS, CO 80524 INSURER D:
INSURER E :
INSURER F :
rtnVFRArF.R CFRTIFICATF NtIMRFR- 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
LTR
TYPE OF INSURANCE
DDL
S BR
POLICY NUMBER
EFF
MM/DD
POLICY
MM/ DI EXP
LIMITS
A
GENERAL LIABILITY
V_
COMMERCIAL GENERAL LIABILITY
Vol
AB9252856
1/1/2018
1/1/2019
EACH OCCURRENCE
$ 1 000 000
PREMISES Ea occurrence
$100,000
CLAIMS -MADE C ✓J OCCUR
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2 000 000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
POLICY ✓ PRO I LOC
AUTOMOBILE LIABILITY
AB9252856
1/1/2018
1/1/2019
NED
EO .'.' d.r") SINGLE LIMIT
1 000 000
BODILY INJURY (Per person)
$
A
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
NON -OWNED
HIRED AUTOS AUTOS
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS-MADE
DED RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXE ..VE
WC STATU- OTH-
TORY LIMITS
E.L. EACH ACCIDENT
$
OFFICER/MEMBER EXCLUDED? ❑
N rA
-- ----- --
(Mandatory in NH)
E.L. DISEASE - EA EMPLOYE
$
E.L. DISEASE - POLICY LIMIT
$
If yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
ADDITIONAL INSURED(S):
CITY OF FORT COLLINS PURCHASING FINANCIAL SERVICES/PURCHASING DIVISION
215 N MASON STREET
2ND FLOOR/PO BOX 580
(CONTINUED)
r9:0TIFICATF Nnl IIFR CANCFI I ATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITY OF FORT COLLINS PURCHASING
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
FINANCIAL SERVICES/PURCHASING DIVISION
215 N MASON STREET
AUTHORIZED REPRESENTATIVE
2ND FLOOR/PO BOX 580
FORT COLLINS, CO 80522
V TytRf-ZUTU AUVKLJ l,U-IKVUKA I JUN. All rlgni5 reserveu.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD