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HomeMy WebLinkAbout568456 HINES INC - INSURANCE CERTIFICATE (2)Client#: 1089324 HINESINC ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 1/06/2017 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 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 USI Colorado, LLC Prof Liab P.O. Box 7050 Englewood, CO 80155 800 873-8500 CONTACT NAME: PHONE g00 873-8500 FAX A/C No Ext : A/C, No E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC N INSURERA: Travelers Indemnity Company 25658 INSURED INSURERB: Travelers Casualty and Surety C 19038 Hines, Inc. 323 W. Drake Road INSURER C : Suite 204 INSURERD: Fort Collins, CO 80526 INSURER E: 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 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. LTRR TYPE OF INSURANCE NSRL WVD POLICY NUMBER POLICY EFF MMLDDY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY X x 6805H725001 12/31/2016 12/31/201 EAACMH�OECCURRENCE $1,000,000 CLAIMS -MADE OCCUR PREMISES Eaoccu ence $1,000,000 MED EXP (Any one person) $10 000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY � PR - POLICY 7 LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 $ OTHER: A AUTOMOBILE LIABILITY X x 6805H725001 12/31/2016 12/31/201 COMBINED SINGLE LIMIT Ea accident 1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Par. er accident $ HIRED AUTOS X NON -OWNED AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? � N / A x UB3873T813 12/31/201612/31/201 X PER OTH- E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000 000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1 000,000 B Professional 105386520 12/31/2016 12/31/201 $1,000,000 per claim Liability $1,000,000 annl aggr. Claims Made DESCRIPTION OF OPERATIONS I 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 and Designated Insured under Automobile Liability but only with respect to liability arising out of the Named Insured work performed on behalf of the certificate holder and owner. The General Liability and Automobile Liability (See Attached Descriptions) City of Fort Collins 215 North Mason Street Fort Collins, CO 80524 GANGELLAT IVN 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 ACORD 25 (2014/01) 1 of 2 #S19644897/M19644365 ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD RDSZP DESCRIPTIONS (Continued from Page 1) insurance applies on a primary and non-contributory basis. A Blanket Waiver of Subrogation applies for General Liability, Automobile Liability and Workers Compensation. Please note that Additional Insured status does not apply to Professional Liability or Workers' Compensation. SAGITTA 25.3 (2014/01) 2 of 2 #Sl96448971M19644365