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HomeMy WebLinkAbout501351 WORKSPACE INNOVATIONS LLC - INSURANCE CERTIFICATE (2)/ AC"R " CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 9/l/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 Moody Insurance Agency, Inc. 8055 East Tufts Avenue Suite 1000 Denver CO 80237 CONTACT Cathy Baker NAME: y PHONN a (303) 824-6600 �: (303)370-0118 E-MAIL Cathy. ins.com ADDRESS: y y INSURERS AFFORDING COVERAGE NAIC S INSURER A :Union Insurance Co 25844 INSURED Workspace Innovations, LLC 4414 E . Harmony Road #100 Fort Collins CO 80528 INSURER B :Pinnacol Assurance 41190 _ INSURERC: INSURER D : INSURER E : INSURERF: COVERAGES CERTIFICATE NUMBER:17-18 Master 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 ADDL JN= SUER POLICY NUMBER MM DYEFF /YYYY MMLI DY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE ❑X OCCUR DANw6t To ED PREMISES Ea oc urrence $ 300,000 MED EXP (Any one person) $ 10,000 X CPA307033423 9/1/2017 2/1/2018 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO I JECT —_J LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ A X ANY AUTO ALL OSCHEDULED AUUTOSS AUTOS _ X CPA307033423 9/1/2017 2/1/2018 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED AUTOS X NON -OWNED AUTOS X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 A EXCESS I" CLAIMS -MADE DED RETENTION$ $ CPA307033423 9/1/2017 2/1/2018 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVEE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N I A 4129130 2/1/2017 2/1/2018 X PER OTH- STATUTE 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 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn : Jennifer Harvey ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 Cathy Baker/RYAMAR ACORD 25 (2014/01) INS025 (201401) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD