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HomeMy WebLinkAboutCITY OF FORT COLLINS - INSURANCE CERTIFICATE (21)FCCIT-1 OP ID: P5 ACORN' CERTIFICATE OF LIABILITY INSURANCE `---� F�A01119DD/YYYY) 01/19/2018 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 Brown 8r Brown Inc 4532 Boardwalk Dr, Suite 200 Fort Collins, CO 80525 Karen E. Siwek, CPA CONTACT NAME: Diana Vigil n/c_ El ; 970-482-7747 ONE qIC No): 970-484-4165 E-MAIL s: dvigil@bbcolorado.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Argonaut Insurance Company 19801 INSURED City of Fort Collins, Colorado PO Box 580 Fort Collins, CO 80522 Fort INSURERB:Markel American Insurance Co. 28932 INSURER C : Midwest Employers Casualty Co. 23612 INSURER D : Navigator Specialty Ins. Co. 36056 INSURER E: Allied World Assurance Co Inc 19489 INSURER F : COVERAGES CERTIFICATE NUMBER: 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 IN POLICY NUMBER POLICY EFF MWDDIYYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 10,000,00 CLAIMS -MADE 1XI OCCUR 2902076-00 05/01/2017 05/01/2018 PREMISES Eaoccurrence $ 1,000,00 X SIR: $500,000 MED EXP (Any one person) $ Contractual Liab PERSONAL & ADV INJURY $ 10,000,00 X SEE FORM CONLIAB•RRS 2013 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 20,000,00 GEN'L POLICY PRO- JECT J❑ LOC EC X PRODUCTS - COMP/OP AGG $ 10,000,00 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 10,000,00 X BODILY INJURY (Per person) $ A ANY AUTO 2902076-00 05/01/2017 05/01/2018 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIREDAUTOS AUTOS I X $ SIR$500000 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,00 AGGREGATE $ 10,000,00 B X EXCESS LIAB CLAIMS -MADE MKLM3EUL100116 05/01/2017 05/01/2018 DED I X RETENTION $ 0 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? ❑NIA (Mandatory In NH) EWC005901 05/01/2017 05/01/2018 X PER TH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,00 D GL Excess 2nd Tier SF17EXC9035101C 06/01/2017 05/01/2018 Limit 10,000,00 E GL Excess 3rd Tier I 0310-7979 07/01/2017 05/01/2018 Limit 20,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Master Certificate ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Karen E. Siwek, CPA © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD FCCIT-1 PAGE 2 NOTEPAD INSURED'S NAME City of Fort Collins, Colorado OP ID: P5 Date 01/19/2018 (2)Additional Policy - Schedule Leased or Rented Equipment Carrier - Allied World Surplus Lines Insurance Company Limit of Liability: $1,000,000 per item $10,000,000 policy limit 05/01/17 to 05/01/18 Property Coverage Carrier - Lexington Insurance Company Policy # 011144405 Property Limits - Blanket Coverage $125,000,000 Deductible $100,000 05/01/17 to 05/01/18