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HomeMy WebLinkAbout366358 JVA INC - INSURANCE CERTIFICATE (9)Client#: 1083121 JVAINC ACORDTM CERTIFICATE OF LIABILITY INSURANCE rDATE(MM/DD/YYYY) 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 CONTACT NAME: USI Colorado, LLC Prof Liab ZONE PHONE $00 873-8500 FAX P.O. Box 7050 Et): (A/C No): E-MAIL — Englewood, CO 80155 ADDRESS: T - 800 873-8500 INSURER(S) AFFORDING COVERAGE NAIC # I INSURER A: Travelers Indemnity Company - 25658 INSURED INSURERB: Pinnacol Assurance Company 41190 JVA,Inc. INSURER C:XL Specialty Insurance Company _ 37885 1319 Spruce Street Travelers Property Cas. Co. of INSURER D : P ►tY 25674 Boulder, Boulder, CO 80302 INSURER E : -------- --- - ---------- --- INSURER F : I COVERAGES CERTIFICATE NUMBER: RFVISInN NUIURFR- 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. LTR TYPE OF INSURANCE IIN RLSIUBR WVD POLICY NUMBER MM/DIDYEFF YY MMIDDY EXP LIMBS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X X _ 68091-1706548 5/01/2017 05/0112018 EACH OCCURRENCE 12,00 60 pAMq� TENTED PREMISis Ea occurrence $1 OOO OOO MED EXP (Any one person) _ $10,000 PERSONAL & ADV INJURY _ $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY � ECOT F LOC GENERAL AGGREGATE $4,000,000 PRODUCTS - COMP/OP AGG $4,000,000 EcD a aoNESINGLE LIMIT $ 1,000,000 D OTHER: AUTOMOBILE LIABILITY I X X BA1696LS78 5/01/2017 05/01/201 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED X HIRED AUTOS X AUTOS $ $ _ BODILY INJURY (Per (P ) PROPERTY DAMAGE Per accident A X UMBRELLA LIAB X EXCESS LIAR _ 1 OCCUR CLAIMS -MADE X X CUP5G343469 05/01/2017 0510112018 EACH OCCURRENCE $8 00O 000 AGGREGATE s8,000,000 DED I X RETENTION $10000 $ 1 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? � N / A X 4131403 5/01/201705/01/201 X PER OTH- IER E.L. EACH ACCIDENT $1 OOO OOO 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 05/01/2018 $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) City of Fort Collins P.O. Box 580 Ft. Collins, CO 80522-0000 LLA I IUN 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 #S20552979/M20443250 © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD YVKZP DESCRIPTIONS (Continued from Pane 11 The General Liability, Automobile Liability, Umbrella/E: contributory basis. A Blanket Waiver of Subrogation al Umbrella/Excess Liability and Workers Compensation. coverage over the General Liability, Automobile Liabili Please note that Additional Insured status does not ap Compensation. Project: 7666 Bobcat Ridge Historic Buildings Rehabili SAGITTA 25.3 (2014/01) 2 of 2 #S20552979/M20443250