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HomeMy WebLinkAbout366358 JVA INC - INSURANCE CERTIFICATE (8)Client#: 1083121 JVAINC ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 5/23/2017 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 N,%NT USl Colorado, LLC Prof Liab PHONE g00 873-8500FAX o A/C No): A/C NExt : P.O. Box 7050 EMAIL Englewood, CO 80155 ADDRESS:-- 800 873-8500 _— INSURER(S) AFFORDING COVERAGE NAIC /t INSURERA: Travelers Indemnity Company 125658 INSURED JVA, IncINSURER B: Pinnacol Assurance Company 141190 . -- 1319 Spruce Street INSURER c : XL Specialty Insurance Company 37885 INSURER D : Travelers Property Cas. Co. of 25674 Boulder, CO 80302 ----- COVERAGES CERTIFICATE NUMRERr R1=VLCInN1 N111u1RFR• 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. LR TR TYPE OF INSURANCE _ ADOLSUB INSR WVD POLICY NUMBER POLICY EFF MMIDD POLICY EXP MM DIN LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [J OCCUR X X _ 68091-11706548 5/01/2017 05/01/2018 s2000OOO $1 OOO OOO pEAACMHAGOECCpURRENCE PREMISES (Ea occu r:nce) MED EXP (Any one person) $10,000 — _ PERSONAL & ADV INJURY $2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: POLICY I GAX ECT LOC GENERAL AGGREGATE s4,000,000 PRODUCTS - COMP/OP AGG I $4 OOO,OOO s - ---- OTHER: I i � D AUTOMOBILE LIABILITY X X _ BA1696LS78 5/01/2017105/011201 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY (Per person) _ $ X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS I BODILY INJURY (Per accident) _ PROPERTY DAMAGE Per accident` $ $ _ $ A X UMBRELLA LIAB X OCCUR I X X CUP513343469 5/01/2017 05/01/201 EACH OCCURRENCE- s8,000,000 AGGREGATE EXCESS LIAR CLAIMS -MADE _- $8,000 000 :DE D X RETENTION $10000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE �Y / N OFFICER/MEMBER EXCLUDED? F7 N/A X 4131403 5/01/2017 05101/201 X PER OTH- TAT ER 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 -- _ _ DPR9913737 E.L. DISEASE -POLICY LIMIT $1,000,000 C Professional 5/01/2017 05/0112018 _ $2,000,000 per claim Liability $3,000,000 annl aggr. Claims Made 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) t tK I II - It -A I t t1ULL1tK UANUIzLLA I JUN City of Fort Collins Operation Services 300 LaPorte Ave., Building B Fort Collins, CO 80521-0000 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 (2014101) 1 of 2 #S20552980/M20443250 © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD YVKZP 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, Umbrella/Excess Liability and Workers Compensation. The Umbrella / Excess Liability policy provides excess coverage over the General Liability, Automobile Liability and Employers Liability. Please note that Additional Insured status does not apply to Professional Liability or Workers' Compensation. City of Fort Collins SAGITTA 25.3 (2014/01) 2 of 2 #S20552980/M20443250