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HomeMy WebLinkAboutCOLORADO STATE UNIVERSITY - INSURANCE CERTIFICATE (2)A� RO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 07/31/2017 I 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 have ADDITIONAL INSURED provisions or 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 ,on Risk Services South, Inc. Franklin TN Office CONTACT NAME: (A/C. No. Ext): (866) 283-7122 F� No ): (B00) 363-0105 E-MAIL ADDRESS: 501 Corporate Centre Drive Suite 300 INSURER(S) AFFORDING COVERAGE NAIC # Franklin TN 37067 USA INSURED INSURER A: Safety National Casualty Corp 15105 Colorado State Uni versi tv INSURER B: Lloyd's syndicate NO. 2987 AA1128987 1251 Mason Street Fort Collins Co 80523-6021 USA INSURER C: INSURER D: INSURER E: INSURER I: COVERAGES CERTIFICATE NUMBER: 5700678517760 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE NSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY PK 1 1 1 1 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X❑ OCCUR SIR applies per policy terns & condi ions DAMAGE TN ED PREMISES Ea occurrence) Included MED EXP (Any one person) PERSONAL &ADV INJURY Included GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $1,000,000 X POLICY ❑ PRO- ❑ LOC JECT PRODUCTS - COMP/OPAGG Included OTHER. B AUTOMOBILE LIABILITY PK1033617 SIR applies per policy terns 08/01/2017 & condi 08/01/2018 ions COMBINED SINGLE LIMIT Ea accident BODILY INJURY ( Per person) $1,000,000 X ANY AUTO BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY AUTOS HIREDAUTOS NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE Per accident B UMBRELLA LIAB OCCUR PK1033617 08/01/2017 08/01/2018 EACH OCCURRENCE $10,000,000 X EXCESS LIAR CLAIMS -MADE SIR applies per policy terns & conditions AGGREGATE $10,000,000 DED I X RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR / PARTNER / EXECUTIVE PER OTH- STATUTE I IER E.L. EACH ACCIDENT 0 FICER/MEMBER EXCLUDED? ❑ N / A E.L. DISEASE -EA EMPLOYEE (Mandatory in NH) If yes, describe under SCP.IPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT A Excess WC sP4057454 08/01/2017 08/01/2018 EL Each Accident $1,000,000 SIR applies per policy terms & conditions EL Disease - Policy $1,000,000 EL Disease - Ea Emp $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: ReC sports Baseball team, Field Rental from City of Fort Collins for 2017 season. The City of Fort Collins is included as Additional Insured on General Liability Policy if required by written contract or agreement subject to the policy terms and conditions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins AUTHORIZED REPRESENTATIVE Attn: Risk Management 215 N. Mason Street, 2nd Floor PO Box 580 Fort Collins Co 80522 USA Gt2Y/aC0 72G! d 0 r` n co 0 0 un 0 Z C1 A V d U ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD