|
ACC>Rif CERTIFICATE OF LIABILITY INSURANCE
<br />161
<br />FDATE(MMIDDM/YY)
<br />1 4/13/2017
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsements .
<br />PRODUCER
<br />USI Colorado, LLC Prof Liab
<br />P.O. Box 7050
<br />CONTACT Kathy Star
<br />NAME,PHONE
<br />.8O0-873-8500 Fax
<br />E-MAIL
<br />Englewood CO 80155
<br />INSURERS AFFORDING COVERAGE
<br />NAIC 4
<br />Y
<br />INSURER A:XLSpecialty Insurance Company
<br />37885
<br />11/14/2016
<br />INSURED INTERCON35
<br />INSURERB:Travelers Indemnity Company of CT
<br />25682
<br />Interwest Consulting Group
<br />P.O. Box 18330
<br />INSURERC:Travelers Property Cas. Co. of Amer
<br />25674
<br />Boulder CO 80308
<br />INSURER 0:
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATF NIIMRFP- 112676864 DC\/ICIAPI %I lI!SED.
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />ILTR
<br />TYPE OF INSURANCE
<br />INSO
<br />NND
<br />POLICY NUMBER
<br />MMIIDIYCY EYYY FF
<br />POLICY EXP
<br />LIMITS
<br />B
<br />X
<br />I COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE FT OCCUR
<br />Y
<br />Y
<br />6806H441235
<br />11/14/2016
<br />11/14/2017
<br />EACH OCCURRENCE $1,000,000
<br />OAMAGET RENTED
<br />PREMISES Eaoccurrence $1,000,000
<br />MED EXP (Any one person) $10,000
<br />PERSONAL &ADV INJURY $1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY jEpT 51 LOC
<br />GENERAL AGGREGATE $2,0005000
<br />GEN'L
<br />PRODUCTS - COMP/OP AGG $2,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />Y
<br />BAOJ093233
<br />11/14/2016
<br />11/14/2017
<br />COMBINED SINGLE
<br />Eaaccident)$1,000,000
<br />X
<br />ANY AUTO
<br />BODILY INJURY (Per person) $
<br />AUTOS NED SCHEDULED
<br />BODILY INJURY (Per accident) $
<br />HIRED AUTOS NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE
<br />Per accident $
<br />C
<br />X
<br />UMBRELLA LIAB
<br />XJ
<br />OCCUR
<br />Y
<br />Y
<br />CUP1330T362
<br />11/14/2016
<br />11/14/2017
<br />EACH OCCURRENCE $4,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE $4,000,000
<br />DED X RETENTION$0
<br />1 $
<br />G
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORTARTNERIEXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? �
<br />NIA
<br />y
<br />UB1339T934
<br />11/14/2016
<br />11/14/2017PER
<br />OTH-
<br />X STATUTE ER
<br />E.L. EACH ACCIDENT $1,000,000
<br />E.L. DISEASE - EA EMPLOYEE $15000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />E.L. DISEASE -POLICY LIMIT $1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />A
<br />Professional Liability
<br />Pollution Liab Included
<br />Claims Made
<br />Y
<br />DPR9726823
<br />11/14/2016
<br />11/14/2017
<br />Per Claim $2,000,000
<br />Annual Aggregate $5,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addltl onal Remarks Schedule, may be attached If more space Is required)
<br />As required by written contract or written agreement, the following provisions apply subject to the policy terms, conditions, limitations and
<br />exclusions: The Certificate Holder and owner are included as Automatic Additional Insured's for ongoing and completed operations under
<br />General Liability; Designated Insured under Automobile Liability; and Additional Insured's under Umbrella / Excess Liability but only with
<br />respect to liability arising out of the Named Insured work performed on behalf of the certificate holder and owner. The General Liability,
<br />Automobile Liability, Umbrella/Excess insurance applies on a primary and non-contributory basis. A Blanket Waiver of Subrogation applies
<br />for General Liability, Automobile Liability, Umbrella/Excess Liability and Workers Compensation. The Umbrella / Excess Liability policy
<br />See Attached...
<br />CERTIFICATE HOLDER CANCELLATION
<br />©1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />Attn: Purchasing Department
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />W.
<br />©1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
|