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HomeMy WebLinkAbout343965 IN-SITU - INSURANCE CERTIFICATE (2)CC)R" AI® �►..� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYVY) 9/6/2017 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 Flood and Peterson PO Box 578 Greeley CO 80632 CONTACT NAME: Katie Lebron-Frank, CISR PHONE Ext (970) 356-0123 CFAX A/C No: (970)330-1867 E-MAIL KLebron-Frank@F1oodPeterson.com ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURERA:Obe - Allianz Insurance Company INSURED In -Situ, Inc. 221 E Lincoln Ave Fort Collins CO 80524 INSURERB:Atlantic Specialty Insurance 27154 INSURERC: INSURERD: INSURER E : INSURERF: COVERAGES CERTIFICATE NUMBER:CL179119335 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 N DLiSU D POLICY NUMBER MOLDY EFY (POLICY YYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE Fx� OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 500,000 VIED EXP (Any one person) $ 10,000 711012769-0006 9/1/2017 9/1/2018 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 PRO - POLICY PRO Y LOC $ OTHER: AUTOMOBILE LIABILITY SINGLE LIMIT Ea accident $ 1, 000, 0008 -CCOMBINED BODILY INJURY (Per person) $ A XANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS 711012769-0006 9/1/2017 9/1/2018 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ X X NON -OWNED HIRED AUTOS AUTOS UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 51000,000 A EXCESS LIAB CLAIMS -MADE DED X RETENTION 0 $ 711012769-0006 9/1/2017 9/1/2018 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 B OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N/A 406041127-0004 9/1/2017 9/1/2018 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 $ 1,000,000 It es, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT A Leased/Rented 711012769-0006 9/1/2017 9/1/2018 $1,000 Deductible 50,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CaF1 I IrII:A I t HULUtH t.AIVt,CLLA I IV14 City of Fort Collins 300 Laporte Ave Fort Collins, CO 80526 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 K Lebron-Frank, CISR/ ACORD 25 (2014/01) INS025 (201401) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD