HomeMy WebLinkAbout- INSURANCE CERTIFICATE (3)ACORDCERTIFICATE OF LIABILITY INSURANCE 0DATE
6/29/09Dnv>
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Van Gilder Insurance Corp. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1515 Wynkoop, Suite 200 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Denver, CO 80202
303 837-8500 INSURERS AFFORDING COVERAGE
INSURED INSURER A: Hartford Fire Insurance Company
The RMH Group, Inc. INSURER B: Hartford Underwriters Insurance Co
12600 West Colfax, Suite A-400 INSURER c: Hartford Ins Co of the MidWest
Lakewood, CO 80215 INSURER D: XL Specialty Insurance Company
INSURER E:
*TiP/;I:%Tc149
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NSR
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MM/DD/YV
POLICY EXPIRATION
DATE MM/DD/VY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 7 OCCUR
34SBAPC7103
07/01/09
07/01/10
EACH OCCURRENCE
$1 000 000
FIRE DAMAGE (Any one fire)
$1 000000
MED EXP (Any one person)
$10 000
PERSONAL & ADV INJURY
$1 000 000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMITAPPLIES PER:
POLICY RO
PCT LOC
JE
PRODUCTS -COMP/OP AGG
s2,000,000
B
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
34UECTZ0905
07/01/09
07/01/10
COMBINED SINGLE LIMIT
(Ea accident)
$1 ,000,000
X
BODILY INJURY
(Per person)
$
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
A
EXCESS LIABILITY
X OCCUR CLAIMS MADE
DEDUCTIBLE
X RETENTION $1 p 000
34SBAPC7103
07/01/09
07/01/10
EACH OCCURRENCE
s4,000,000
AGGREGATE
s4,000,000
$
$
C
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
34WEGNA3768
07/01/09
07/01/10
XTU
DRY WC sT MITS I OE I
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE - EA EMPLOYEE
$1,0009000
E.L. DISEASE • POLICY LIMIT
$1 000 000
D
OTHER Professional
Liability
laims Made
DPR9619061
07/01/09
07/01/10
2,000,000 per claim
$2,000,000 anni aggr.
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
The City of Fort Collins is listed as an Additional Insured, under General Liability only, in respect to their interest in
work performed by the insured as per written specified contracts.
ULK I WILA I L NULULK I I ADDITIONAL INSURED: INSURER LETTER: (:ANUhLLA I IUN
City of Fort Collins
Attn: John Stephen, Purchasing
P.O. Box 580
Fort Collins, CO 80522-0580
SHOULD ANYOFTH E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAIL3.0_DAYSWRITTEN
NOTWETOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT, BUTFAILURE TODOSOSHALL
IMPOSE NOOBLIGATION OR LIABILITYOF ANYKIND UPON THE INSURERJTS AGENTS OR
A HORI2ED REPRESENTATIV
ACORD 25-S (7/97)1 of 2 #M569544 KAB 0 ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD25-S(7/97)2 of 2 #M569544