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Home My WebLink About110150 CATHOLIC CHARITIES NORTHERN - INSURANCE CERTIFICATE (2)The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) AUTHORIZED REPRESENTATIVE CANCELLATION CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) JECT LOC POLICY PRO- GEN'L AGGREGATE LIMIT APPLIES PER: CLAIMS-MADE OCCUR COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ DED RETENTION $ CLAIMS-MADE OCCUR $ AGGREGATE $ UMBRELLA LIAB EACH OCCURRENCE $ EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS PER STATUTE OTH- ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNED AUTOS AUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) Certificate Holder Company Affording Coverage This Certificate is issued as a matter of information only and confers no rights upon the holder of this certificate. This certificate does not amend, extend or alter the coverage afforded below. This is to certify that the coverages listed below have been issued to the certificate holder named above for the certificate 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 coverage afforded described herein is subject to all the terms, exclusions and conditions of such coverage. Limits shown may have been reduced by paid claims. Type of Coverage Certificate Number Coverage Effective Date Coverage Expiration Date Limits Other D. General Liability Excess Liability Should any of the above described coverages be cancelled before the expiration date thereof, the issuing company will endeavor to mail ________ days written notice to the holder of certificate named to the left, but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives. Authorized Representative Property Occurrence Real & Personal Property Each Occurrence Each Occurrence General Aggregate Products-Comp/OP Agg Personal & Adv Injury Each Occurrence Fire Damage (Any one fire) Med Exp (Any one person) Claims Made Covered Location Certificate of Coverage Date: Coverages Holder of Certificate Cancellation Annual Aggregrate Limit/Coverage Claims Made Annual Aggregrate Description of Operations/Locations/Vehicles/Special Items (the following language supersedes any other language in this endorsement or the Certificate in conflict with this language) Additional Protected Person(s) Archdiocese of Denver 1300 S. Steele Street Denver, CO 80210 CCS North - Larimer County Region 460 Linden Center Drive Fort Collins, CO 80524 10/23/2014 THE CATHOLIC MUTUAL RELIEF SOCIETY OF AMERICA 10843 OLD MILL RD OMAHA, NE 68154 Coverage only extends for claims arising out of Catholic Community North - Larimer County Region fulfillment of its obligation as outlined in the agreement with the City of Fort Collins for the Utility Assistance Program, for the term of the certificate. CMRS Excess ENDORSEMENT (TO BE ATTACHED TO CERTIFICATE) Effective Date of Endorsement: ___________ Cancellation Date of Endorsement: ___________ Certificate Holder: Location: Certificate No. ________ of The Catholic Mutual Relief Society of America is amended as follows: SECTION II - ADDITIONAL PROTECTED PERSON(S) It is understood and agreed that Section II - Liability (only with respect to Coverage D - General Liability), is amended to include as an Additional Protected Person(s) members of the organizations shown in the schedule, but only with respect to their liability for the Protected Person(s) activities or activities they perform on behalf of the Protected Person(s). It is further understood and agreed that coverage extended under this endorsement is limited to and applies only with respect to liability assumed by contract or agreement; and this extension of coverage shall not enlarge the scope of coverage provided under this certificate or increase the limit of liability thereunder. Unless otherwise agreed by contract or agreement, coverage extended under this endorsement to the Additional Protected Person(s) will not precede the effective date of this certificate of coverage endorsement or extend beyond the cancellation date. Schedule - ADDITIONAL PROTECTED PERSON(S) Remarks (the following language supersedes any other language in this endorsement or the Certificate in conflict with this language): PKS-122(10-11) ______________________________________ Authorized Representative CCS North - Larimer County Region 460 Linden Center Drive Fort Collins, CO 80524 7/1/2014 7/1/2015 Archdiocese of Denver 1300 S. Steele Street Denver, CO 80210 8858 City of Fort Collins, its officers, agents and employees Coverage only extends for claims arising out of Catholic Community North - Larimer County Region fulfillment of its obligation as outlined in the agreement with the City of Fort Collins for the Utility Assistance Program, for the term of the certificate. CMRS Excess Auto $500,000 xs $500,000. Auto $500,000 xs $500,000. City of Fort Collins, its officers, agents and employees 0018004898 10 ✔ 8858 7/1/2014 7/1/2015 1,000,000 Excess Automobile 8858 7/1/2014 7/1/2015 500,000 PROPERTY DAMAGE $ $ $ $ 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. INSD ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) OTHER: 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). COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: INSURED PHONE (A/C, No, Ext): PRODUCER ADDRESS: E-MAIL FAX (A/C, No): CONTACT NAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 7/14/2014 Arthur J. Gallagher Risk Management Services, Inc. 6399 S. Fiddlers Green Cir Greenwood Village CO 80111 Archdiocese of Denver 1300 S. Steele Street Denver, CO 80210-2599 Zurich American Insurance Company 16535 950384000 A N EWS0173359 00 7/1/2014 7/1/2015 X 1,000,000 1,000,000 1,000,000 Limit Excess Workers Compensation Self Insured Retention of $250,000 Evidence of Insurance only. Catholic Charities 4045 Pecos St. Denver CO 80211 USA