HomeMy WebLinkAboutHUMPHRIES POLI ARCHTECTS PC - INSURANCE CERTIFICATEClient#: 1084379 HUMPHPOL
ACORD,. CERTIFICATE OF LIABILITY INSURANCE F-ATE(MM/DD/YYYY)
5/24/2017
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()es) 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 iCONTACT
NAME:
US[ Colorado, LLC Prof Liab HONE El): 800 873-8500
P.O. Box 7050 (Arc No):
E-MAIL
Englewood, CO 80155 ADDRESS:
800 873-8500 INSURER(") AFFORDING COVERAGE NAIC li
INSURER A: Hartford Casualty Insurance Corn 29424
INSURED
Humphries Poll Architects, PC
1655 Grant St
Denver, CO 80203
INSURERB: Admiral Insurance Company 24856
INSURER C : Hartford Underwriters Insurance 30104
INSURER D :
INSURER E :
CCVFROr,F.R rcoTrcrrwrc kit Ins- .
nQrrarvill rrumor-M
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.
INSR ADDL SUB POLICY EFF POLICNEX
LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYYY MM/ ICLIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
X
X
34SBWGC5644
6/02/20171
O6/O2ECCURRENCE
$1 000 000
ES EaExcu enos
$3OO OOO
P (Any one person)
$10,000
AL & ADV INJURY
$1,000,000
GEN'L
AGGREGATE LIMIT APPLIES PER:L
POLICY � ECT LOC
AGGREGATE
$2,000,000
CTS-COMP/OPAGG
$2,000,000
OTHER:
610=017
06/02Ea
D SINGLE LIMIT
1,000,000
(;
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
HIRED AUTOS X NON -OWNED
AUTOS
X
X
34UEGP05860
X
X
INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
$
A
X
UMBRELLA LIAB
EXCESS LIAR
X
OCCUR
CLAIMS -MADE
X
N/A
X
34SBWGC5644
6/02/2017 06/02/201
6/02/2017 06/0212018
EACH OCCURRENCE
$2 000 000
AGGREGATE
$2 OOO OOO
DED X RETENTION $10000
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N
OFFICER/MEMBEREXCLUDED? ❑
Mandatory in if yes, describe under
DESCRIPTION OF OPERATIONS below
PER OTH-
$
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT $
$2,000,000 per claim
$4,000,000 annl aggr.
B
Professional
Liability
Claims Made
E000002921503
DESCRIPTION OF OPERATIONS / 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; Designated Insured under
Automobile Liability; and Additional Insureds under Umbrella / Excess Liability but only with respect to
liability arising out of the Named Insured work performed on behalf of the certificate holder and owner.
(See Attached Descriptions)
City of Fort Collins
Attn: Purchasing Dept.
PO Box 580
Fort Collins, CO 80522
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
#S20559585/M20557750
v'IVWS-21JI4 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
BTRZP
I DESCRIPTIONS (Continued from Page 1)
The General Liability, Automobile Liability, Umbrella/Excess insurance applies on a primary and non
contributory basis. A Blanket Waiver of Subrogation applies for General Liability, Automobile Liability and
Umbrella/Excess Liability. The Umbrella / Excess Liability policy provides excess coverage over
the General Liability, Automobile Liability and Employer's Liability.
Please note that Additional Insured status does not apply to Professional Liability.
RE: Fort Collins Library.
Additional Insureds include: City of Fort Collins, its officers, agents and employees and Poudre River
Public Library District (District)
SAGITTA 25.3 (2014/01) 2 of 2
#S20559585/M20557750