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HomeMy WebLinkAbout129729 EXODUS MOVING & STORAGE INC - INSURANCE CERTIFICATE (15)EXODU-1 OP ID: DA '4�oRo' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/30/2017 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 CONTA_NAME: CT Diana Vigil Brown & Brown Inc 4532 Boardwalk Dr, Suite 200 (A/CNo. Extr.970-482-7747 jvc No): 970-484-4165 Fort Collins, CO 80525 ADDRESS: dvigil@bbcolorado.com Karen E. Siwek, CPA INSURERS AFFORDING COVERAGE NAIC # INSURER A:Employers Mutual Casualty Co. 21415 INSURED Exodus Moving and Storage Inc INSURERB: 120 NE Frontage Rd Unit D INSURERC: Fort Collins, CO 80524 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE Nl1MRFR- RFVMI(1N NI IMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF !NSURANCE 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 A DL UBRI POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE C OCCUR X X 5D73266 09/01/2017 09/01/2018 DAMAGES( RENTED PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 500,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY PRO- ❑ JECT LOC PRODUCTS -COMP/OP AGG $ 2,000,00 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,00 X BODILY INJURY (Per person) A ANY AUTO X X 5A73266 09/01/2017 09/01/2018 _ _ $ ALL OWNED SCHEDULED AUTOS AUTOS $ BODILY INJURY (Per accident) P O cRentDAMAGE NON -OWNED HIRED AUTOS AUTOS $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 A EXCESS LIAB CLAIMS -MADE 5J73266 09/01/2017 09/01/2018 DED X RETENTION $ 10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N / A X 5H73266 09/01/2017 09/01/2018 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 If yes. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,00 A Warehousemen 73266 09/01/2017 09/01/2018 Warehouse 1,750,00 A Excess Liab. 7AHSFF110891-00 09/01/2017 09/01/2018 ExcessLib 4,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is included as additional insured per policy forms and conditions on page 2. 1091 CITYOFF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. Purchasing Department PO Box 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD EXODU-1 PAGE 2 NOTEPAD INSURED'S NAME Exodus Moving and Storage Inc OP ID: DA Data 08/30/2017 When required by written contract the following applies: General Liability: Blanket Additional Insured Blanket Waiver of Subrogation Blanket Primary & Non-contributory utomobile: Blanket Additional Insured Blanket Waiver of Subrogation Workers Compensation: Colorado Blanket Waiver of Subrogation kers Compensation - Other States EXODU-1 OP ID: DA CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/30/2017 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 Brown & Brown Inc 4532 Boardwalk Dr, Suite 200 CONTACT NAME: Diana Vigil PHONE 970-482-7747 WC A/c No Ext : A/c No : 970-484-4165 ADDRIESS: dvigil@bbcolorado.com Fort Collins, CO 80525 Karen E. Siwek, CPA INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Employers Mutual Casualty Co. 21415 INSURED Exodus Moving and Storage Inc 120 NE Frontage Rd Unit D Fort Collins, CO 80524 INSURERB: INSURER C INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: TINS IS TO CERTIFY THAT THE POLICIES OF ;NSUKANCE LISTED BEL&W 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 TYPE OF INSURANCE DDL UBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERALLIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE X OCCUR X 5D73266 09/01/2017 09/01/2018 DAMAGE TO RENTED PREMISES Ea occurrence $ 1 OO OO MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 500100 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY PRO- ❑ JECT LOC PRODUCTS - COMP/OPAGG $ 2,000,00 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ , 000 1 ,00 X BODILY INJURY (Per person) $ A ANY AUTO X 5A73266 09/01/2017 09/01/2018 ALL OWNED j SCHEDULED AUTOS AUTOS $ BODILY INJURY (Per accident) I PeOaccidenDAMAGE $ NON -OWNED HIRED AUTOS AUTOS $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 A EXCESS LIAB CLAIMS -MADE X 5J73266 09/01/2017 09/01/2018 DED FX RETENTION $ 10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 5H73266 09/01/2017 09/01/2018 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE - POLICY LIMIT $ 1,000,00 A Warehousemen 5C73266 09101/2017 09101/2018 Warehouse 1,750,00 A Excess Liab. AHSFF110891-00 09/01/2017 09/01/2018 ExcessLib 4,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins and its elected & appointed officials & employees are included as additional insureds as their interests may appear on the general liability & auto liability if required by written contract. Waiver of subrogation applies on the workers compensation if required by written contract per form 359b CERTIFICATE HOLDER CANCELLATION FORTCOL City of Fort Collins Purchasing P.O. 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 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD EXODU-1 PAGE 2 NOTEPAD INSURED'S NAME Exodus Moving and Storage Inc OP ID: DA Date 08/30/2017 When required by written contract the following applies: neral Liability: anket Additional Insured anket Waiver of Subrogation anket Primary 6 Non-contributory tomobile: anket Additional Insured anket Waiver of Subrogation rkers Compensation: Colorado anket Waiver of Subrogation rkers Compensation - Other States EXODU-1 OP ID: DA ACORO" CERTIFICATE OF LIABILITY INSURANCE ATE 08/30120YYYY) 8/30/2017 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 Brown & Brown Inc 4532 Boardwalk Dr, Suite 200 Fort Collins, CO 80525 CONTANAME: CT Diana Vigil PHONE 970-482-7747 FAX (A/c. No. E,): (A/c, No): 970-484-4165 ADDRIESS: dvigil@bbcolorado.com Karen E. Siwek, CPA INSURERS AFFORDING COVERAGE NAIC # INSURER A:Employers Mutual Casualty Co. 21415 INSURED Exodus Moving and Storage Inc 120 NE Frontage Rd Unit D Fort Collins, CO 80524 INSURERB: INSURERC: INSURER D : INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 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. INSR LTR TYPE OF INSURANCE ADDILSUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE r� OCCUR 5D73266 09/01/2017 09/01/2018 DAMAGE ( RENTED PREMISES Ea occurrence) $ 100,00( MED EXP (Any one person) $ 10,00( PERSONAL & ADV INJURY $ 500,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY ❑ PRO- ❑ JECT LOC PRODUCTS -COMP/OP AGG $ 2,000,00 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,00 BODILY INJURY (Per person) A X ANY AUTO 5A73266 09/01/2017 09/01/2018 $ ALL OWNED AUTOS AUTOS SCHEDULED BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 A EXCESS LIAB CLAIMS -MADE 5J73266 09/01/2017 09/01/2018 DED X I RETENTION $ 10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 5H73266 09/01/2017 09/01/2018 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N / A E.L. DISEASE - EA EMPLOYEE $ 1,000,00 It yes, describe under DESCRIPTION OF OPERATIONS below $ 1,000,00( E.L. DISEASE - POLICY LIMIT A Warehousemen _T 5C73266 09101/2017 09/01/2018 Warehouse 1,750,00 A Excess Liab. � AHSFF110891-00 09/01/2017 09/01/2018 �ExcessLib 4,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CITYDIV City of Fort Collins Purchasing Division Attn: David Carrey PO Box 580 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 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD EXODU-1 PAGE 2 NOTEPAD INSURED'SNAME Exodus Moving and Storage Inc OP ID: DA Date 08/30/2017 When required by written contract the following applies: neral Liability: anket Additional Insured anket Waiver of Subrogation anket Primary 6 Non-contributory tomobile: anket Additional Insured anket Waiver of Subrogation rkers Compensation: Colorado anket Waiver of Subrogation rkers Compensation - Other States