CERTIFICATE HOLDER
© 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09)
AUTHORIZED REPRESENTATIVE
CANCELLATION
DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
LOC
JECT
PRO-
POLICY
GEN'L AGGREGATE LIMIT APPLIES PER:
OCCURCLAIMS-MADE
COMMERCIAL GENERAL LIABILITY
GENERAL LIABILITY
PREMISES (Ea occurrence)
$
DAMAGE TO RENTED
EACH OCCURRENCE $
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS - COMP/OP AGG $
$RETENTION
DEDUCTIBLE
CLAIMS-MADE
OCCUR
$
$
AGGREGATE $
EACH OCCURRENCE $
UMBRELLA LIAB
EXCESS LIAB
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
INSR
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
LIMITS
WC STATU-
TORY LIMITS
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 AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
$
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE
(Per accident)
$
$
$
$
INSR
ADDL
WVD
SUBR
N / A
$
$
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).
The ACORD name and logo are registered marks of ACORD
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
INSURED
PHONE
(A/C, No, Ext):
PRODUCER
PRODUCER
CUSTOMER ID #:
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
3/27/2019
CB Insurance, LLC
1 South Nevada Ave., Suite 230
Colorado Springs CO 80903
719-228-1070
719-228-1071
PEREMAS-01
Peregrine Master Association, Inc.
c/o Z&R Property Management
6015 Lehman Drive, Ste 205
Colorado Springs CO 80918
National Surety Corporation
Westchester Fire Insurance Co.
10030
PMA Companies
959324583
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.
B
X
ASNCOF147966661
3/15/2019
3/15/2020
1,000,000
100,000
X
5,000
1,000,000
2,000,000
2,000,000
X
Hired&Nonowned Autos
Included
A
X
X
X
SUO00049054554-13659-4
3/15/2019
3/15/2020
5,000,000
5,000,000
0
C
201901-10-70-89-5Y
4/1/2019
3/15/2020
X
1,000,000
1,000,000
1,000,000
B
Association
Covered Property
Common Areas Only
ASNCOF147966661
3/15/2019
3/15/2020
Replacement Cost
$1,347,600
$5,000 DED
See Attached...
MASTER CERTIFICATE
XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX XX XXXXX
10
ACORD 101 (2008/01)
The ACORD name and logo are registered marks of ACORD
© 2008 ACORD CORPORATION. All rights reserved.
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: FORM TITLE:
ADDITIONAL REMARKS
ADDITIONAL REMARKS SCHEDULE
Page of
AGENCY CUSTOMER ID:
LOC #:
AGENCY
CARRIER NAIC CODE
POLICY NUMBER
NAMED INSURED
EFFECTIVE DATE:
PEREMAS-01
1
1
CB Insurance, LLC
Peregrine Master Association, Inc.
c/o Z&R Property Management
6015 Lehman Drive, Ste 205
Colorado Springs CO 80918
25
CERTIFICATE OF LIABILITY INSURANCE
Fidelity Policy Named Insured Includes Property Management Company:
Z&R Property Management
6015 Lehman Drive, #205
Colorado Springs, CO 80918
COVERAGE: Crime/Fidelity/Employee Dishonesty
INSURER: Continental Casualty Company
POLICY NUMBER: 618663959
LIMIT: $950,000 DED: $5,000
POLICY DATES: 3/15/2019 To 3/15/2020
COVERAGE: Directors & Officers Liability
INSURER: Continental Casualty Company
POLICY NUMBER: 618663959
LIMIT: $1,000,000 DED: $10,000
AGGREGATE: $1,000,000
POLICY DATES: 3/15/2019 To 3/15/2020
COVERAGE: Volunteer Accident Liability
INSURER: QBE Insurance
POLICY NUMBER: BINDER4119
LIMIT: $50,000 DED: $250
POLICY DATES: 4/1/2019 To 3/15/2020
AT
