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HomeMy WebLinkAboutEVERLAST CLIMBING INDUSTRIES INC - INSURANCE CERTIFICATEACOROa DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 08/01/2017 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 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 CONTACT Marsh USA, Inc. _NAME: _ __ PHONE FAX Two Alliance Center AI AI c No 3560 Lenox Road, Suite 2400 E-MAIL Atlanta, GA 30326 ADDRESS: Ann: Atlanta,CertRequest@marsh.com / Fax: 212-948-4321 INSURERS AFFORDING COVERAGE NAIC # 457102-CTS-GAUWX-17-18 INSURER A: Westchester Surplus Lines Insurance Co 10172 INSURED Everlast Climbing Industries, Inc. INSURER B : Travelers Property Casualty Company Of America 25674 dba Colorado Time Systems, Inc. INSURER C : National Union Fire Insurance Co. of Pittsburgh, PA 19445 1551 E 11th St. INSURER D : Charter Oak Fire Insurance Company- 25615 Loveland, CO 80537 — — INSURER E: Liberty Surplus Insurance Corp 10725 INSURER F : Phoenix Insurance Company 25623 COVERAGES CERTIFICATE NUMBER: ATL-004365421-20 REVISION NUMBER: 9 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. INSR LTR I TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY G2821800A001 02/01/2017 08/01/2018 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE � OCCUR PREMISES Ea oNED nce $ 100,000 X MED EXP (Any one person) $ EXCLUDED SIR $10,000 Per Occ. PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY FT] ECT LOC PRODUCTS - COMPlOP AGG $ 4,000,000 POLICY AGGREGATE $ 10,000,000 OTHER: B AUTOMOBILE LIABILITY TJ-CAP-9D897065TIL-17 08/01/2017 08/01/2018 COEaMBINED ccidentSINGLE LIMIT a $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Comp/Coll Ded: $1,000 $ X UMBRELLALIAB X OCCUR 1000054456-07 08/01/2017 08/01/2018 EACH OCCURRENCE $ 25,000,000 AGGREGATE $ 25,000,000 EXCESS LIAB CLAIMS -MADE DED I X I RETENTION $ 10,000 $ F D G WORKERSCOMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIE7OR/PARTNERlEXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA TC2NUB-9D900314-17(AOS) TRO-UB-9D90032-6-17 (AZ,FL,OR,Wt) 7J602089-17 AL ( ) THUM 17 08/01/2017 08/01/2017 08/01/2018 08/01/2018 08/01/2018 X PER OTH- STATUTE I ER E. L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 If yes describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 E Excess Umbrella 1000054456-07 08/01/2017 08/01/2018 Each Occurrence 25,000,000 Aggregate 25,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: RFP 8107 - Athletic Field Scoreboards City of Fort Collins is listed as additional insured as their interests may appear, during and until completion of the project, on a primary and non-contributory basis, on the General Liability via CG 2010 & CG 2037 and Automobile Liability via CA T4 37 08 08 policies, as required by written contract. A Waiver of Subrogation applies in favor of the additional insureds on the Workers Compensation policy, where required by written contract. City of Fort Collins PO Box 580 Fort Collins, CO 80522 L�L'13 l 3llA-Ali@iil 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 of Marsh USA Inc. Manashi Mukherjee _Mnvv�n oo►,: .3i4L,�.na�cs @ 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ACOR" AGENCY Marsh USA, Inc. POLICY NUMBER CARRIER AGENCY CUSTOMER ID: 457102 LOC #: Atlanta ADDITIONAL REMARKS SCHEDULE NAIC CODE NAMED INSURED Everlast Climbing Industries, Inc. dba Colorado Time Systems, Inc. 1551 E.11th St. Loveland, CO 80537 EFFECTIVE DATE: ADDITIONAL KtMAKK3 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance INSURERS AFFORDING COVERAGEINAIC # INSURER G: Travelers Property Casualty Insurance Company (36161) Page 2 of 2 i nnno wnr�on l�nDof�DATIlIIJ A11 rinhfc rncarvad ACORD 101 (2008/01) _ .._- •__ The ACORD name and logo are registered marks of ACORD DATE (MMIDD/YYYY) AC - CERTIFICATE OF LIABILITY INSURANCE 08/0 /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 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 CONTACT Marsh USA, Inc. NAME: PHONE JFAX Two Alliance Center lA/c No): 3560 Lenox Road, Suite 2400 E-MAIL Atlanta, GA 30326 ADDRESS: Attn: Atlanta.CertRequest@marsh.com / Fax: 212-948-4321 INSURERS AFFORDING COVERAGE NAIC # 457102-CTS-GAUWX-17-18 INSURER A : Westchester Surplus Lines Insurance Co 10172 INSURED Everlast Climbing Industries, Inc. INSURER B : Travelers Property Casualty Company Of America 25674 dba Colorado Time Systems, Inc. INSURER C : National Union Fire Insurance Co. of Pittsburgh, PA 19445 1551 E. 11th St. INSURER D : Charter Oak Fire Insurance Company 25615 Loveland, CO 80537 INSURER E : Liberty Surplus Insurance Corp10725 INSURER F : Phoenix Insurance Company 25623 COVFRAGFS CFRTIFICATF NIIMRFR- ATL-004365418-15 REVISION Nt1MRFR- 1 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. INSR LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMlDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY G2821800A001 02/01/2017 08/01/2018 EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE Fx] OCCUR A AGE To RENTE— PREMISES Ea occur ante $ 100,000 X MED EXP (Any one person) $ EXCLUDED SIR $10,000 Per Occ. PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 4,000,000 POLICY PE O LOC PRODUCTS - COMP/OP AGG $ 4,000,000 POLICY AGGREGATE $ 10,000,000 OTHER. B AUTOMOBILE LIABILITY TJ-CAP-9D897065TIL-17 08/01/2017 08/01/2018 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTYDAMAGE Per accident $ _ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Comp/Coll Ded: $1,000 $ X UMBRELLA LIAB X OCCUR 1000054456-07 08/01/2017 08/01/2018 EACH OCCURRENCE $ 25,000,000 AGGREGATE $ 25,000,000 EXCESS LIAR CLAIMS -MADE DED I X I RETENTION $10,000 $ F p G WORKERS COMPENSATION AND EMPLOYERSLIABILITY ' YIN ANYPROOFFIC RPM MBEREXCLUDED?ECUTIVE N (Mandatory in NH) NIA 7C2NUB-9D900314-17(AOS) TRO-UB-9D90032-6-17 (AZ,FL,OR,WI) 7J602089-17 (AL) 08/01/2017 08/01/2017 08/01/2018 08/01/2018 08/01/2018 X PER OTH - STATUTE ER E.L.EACHACCIDENT $ t W0 000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 E Excess Umbrella 1000054456-07 08/01/2017 08/01/2018 Each Occurrence 25,000,000 FF Aggregate 25,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: RFP 8107 — Athletic Field Scoreboards City of Fort Collins is listed as additional insured as their interests may appear, during and until completion of the project, on a primary and non-contributory basis via 80-02-2367, as required by written contract. A Waiver of Subrogation applies in favor of the additional insureds on the Workers Compensation policy, where required by written contract. rFRTI1=IrATF Nnl nFR CANCFI 1 ATION City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO Box 580 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Fort Collins, CO 80522 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee rrf raL- �laes►.: ti�iat.� t,�..,t,.t� ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 457102 LOC #: Atlanta A�(JKL AUUI I IUIVAL KGIVIHRnJ J%.nKZUUL-lL-- AGENCY NAMED INSURED Marsh USA, Inc. Everlast Climbing Industries, Inc. dba Colorado Time Systems, Inc. POLICY NUMBER 1551 E. 11th St. Loveland, CO 80537 CARRIER :E2E EFFECTIVE DATE: H UUIIIV IYHL I�G.IM.�f�V THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance INSURERS AFFORDING COVERAGEMAIC # INSURER G: Travelers Property Casualty Insurance Company (36161) I M ilo nllo w TW%L1 A11 . •. 6•4c eocnr�•n•i ACORD 101 (2008/01) r,,,.-•-.- - - - The ACORD name and logo are registered marks of ACORD