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Home My WebLink AboutEXPRESS SERVICES - INSURANCE CERTIFICATEACORD. DATE MIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 09/2 9/28(O6 PRODUCER 1-918-584-1433 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Arthur J. Gallagher Risk Management Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 3142 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Tulsa, OR 74101-3142 INSURERS AFFORDING COVERAGE 1 NAIC# INSURED INSURERA:National Union Fire Ins Cc Of Pitts 19945 Express Services, Inc. - - - - -- - --- - -. INSURERS: American HOme AeSur CO 19380 8516 NN Expressway INSURER C: Birmingham Fire Ins Co Of PA �19402 Oklahoma City, OR 73162 ER D: Insurance Cc Of The State Of PA 29429 INSURER _. _. - _ _. _. - _.. _. _. � Cr1VFRAr:FR 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. INSR DD' POLICYEXPIRTI7N ATI POLICYNUMBER DATE IEFFECTIVE UNITS A GENERAL LIABILITY SSL9518899 30/01/06 10/02/07 EACH OCCURRENCE $5,000,000 X COMMERCIAL GENERAL LIABILITY _ _ _ PgEM SE �O RENTED 250, 000 PREMISES oar I�noJ— _ $ 0 CLAIMS MADE j OCCUR MED EXP (A one�amon) _ $ 5, 000_ _ X Staffing Services - _ PERSONAL& ADV INJURY. I Incl.E&O GENERAL AGGREGATE $ 5,000,000 GENT AGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/OPAGG Included X POLICY PRO- LOC A AUTOMOBILE LIABILITY SSL9518S99 10/01/06� 10/01/07 COMBINED SINGLE LIMIT $1,000,000 ANY AUTO (Ea accident) ALLOWNEDAUTOS BODILY INJURY ?(Par SCHEDULEDAUTOS pem°n) $ X HIREDAUTOS BODILYINJURV $ X NON-OWNEDAUTOS (PoraccMeM) - -- --- -- — -- -- - PROPERTY DAMAGE $ (Peramident) GARAGE LIABILITY AUTO ONLY EA ACCIDENT_ — — $ - - - - -- -- ANY AUTO EA ACC OTHER THAN $ - -- - -- - AUTO ONLY: AGG $ A LIABILITY 6994654 10/01/06 10/01/07 EACH OCCURRENCE $ 5,000, 000 OCCUR [� CLAIMS MADE AGGREGATE $5,000, 000 rEXCESMMBRELLA DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND INC2920155 10/01J06 20/01/07 E WCS7ATU- OTW ZQRYLMITS_. �..ER C EMPLOYERS'LULBILIIY NC2920156 10/01/0 10/01/07 _ EL EACH ACCIDENT $1 000,000 ANYPROPRIETOR/PARTNER/EXECUTIVE INC -- D OFFICER&ArMSER EXCLUDED? EXCL SEE ATTACHED LIST 10/01/06 10/01/07 El_DISEASE -EA EMPLOYEE $1 000,000 I es, describe under SPECIAL PROVISIONS bebw - E.L. DISEASE -POLICY LIMIT $1,000,000 OTHER A Crime/fidelity 7520572 10/01/06 10/01/07 :Crime 11000,000 A Staffing B&O Cvg. SSL9518899 10/01/06 10/01/07 E&O Occ./Agg. 51000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/ EXCLUSIONS ADDED BY 15NDORSEMENTI SPECIAL PROVISIONS Location: 1016 - Ft. Collins, CO Type of Company: City Municipality Job Description: Clerical, administrative assistant All insurance carriers shown on this certificate have an A.M. Best Ratia of A+XV unless otherwise noted. c-Fr Ft/-Ar mum nwm r_eau-tor I annu SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Fort Collins DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL James O'Neill P.O. Box 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Fort Collins, CO 80524 USA AGUKU Y5(YW71U8) macaaiie_ga.Loretni ®AGOKD CORPORATION 7885 4933073 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. 26 SUPPLEMENT TO CERTIFICATE OF INSURANCE DATE o9/ae/o6 NAME OF INSURED: Express Services, Inc. Additional Description of Operations/Remarks from Page 1: Additional Information: Workers- Compensation Policy Schedule: Policies Effective: 10-1-06 Policies Expiration: 10-1-07 Co. No. Policy No. States Covered: D. NC2920157 AR,AL,AR,AZ,CO,CT,DC,DE,OA,NI,IA,ID,IL,IN,ES,EY,LA,NA,MD,NE,NI, NN,NO,NS,NT,NC,NE,NN,NJ,MK,NV,NY,OR,PA,SC,SD,TN,TY,DT,VA A. KC2920156 WI (ND,ON,WA,WV,WY &W.Liab.oaly) H. NC2920255 CA E. WC2920159 rL C. WC2920158 OR SUPP (05/04) ACORD,,, CERTIFICATE OF LIABILITY INSURANCE DATE 8/06IYYYY) 09/28(06 PRODUCER 1-918-584-1433 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Arthur J. Gallagher Risk Management Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR P.O. Box 3142 ALTER THE COVERAGE AFFORDED BY THE POLICIES BE Tulsa, OR 74101-3142 j INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: National Union Fire Ins Co Of Pitts 19445 Express Services, Inc. - _. _ -. _ -_ _. - -- -.. _. _. - I _.. INSURER_ B: American Rome Assur Cc 19380 8516 NN Expressway Wm Birmingham- INSURER Hire Ins Co Of PA 19902 Oklahoma City, OR 73162 INSURER D: Insurance Co Of The State Of PA 19429 r_nVFRArr__q 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. TYPE OFINSURANCE INSR DD POLICY NUMBER POLICY EFFECTIVE POLICYEXPIRATI)N LIMITS A GENERAL LIABILITY SSL9518899 10 Ol D6 20/01/07 EACH OCCURRENCE $5,000,000 COMMERCIAL GENERAL -g�— _ PREMI ETOREN7ED wrenc�e _ $ 250,000 —1 FX IAOCCUR _. E MEDEXE$(,E MED EX�Any one person) $5 000- _ _ J 9taffia Services 9 PERSONALBADV INJURY Incl. Sao S_ GENERALAGGREGATE $5 00o,o00 GENT AGGREGATE LIMITAPPLIES PER: PRODUCTS-COMPlOPAGG $Included X I PRO- POLICY LOC A AUTOMOBILE LIABILITY - SSL9518899 10/01/06 10/01/07 COMBINED SINGLE LIMB g1, 000, 000 _ ANYAUTO (Ea accident) ALLOWNEDAUTOS BODILY INJURY $ SCHEDULEDAUTOS (Per Person) _ HIREDAUTOB BODILY INJURY $ T NON-0WNEDAUTOS (Peraccident) PROPERTY DAMAGE $ (PeracGdent) GARAGE LIABILITY AUTO ONLY-EAACCIDENT $ _ _ ANYAUTO OTHERTHAN EA ACC — — $— — - --- AUTO ONLY: AGG $ A EXCESSMMSRELLA LIABILITY 6994654 10/01/06 10/01/07 EACH OCCURRENCE_--- $ 51000,000 X [ OCCUR CLAIMS MADE AGGREGATE $ 5 .00,000 — DEDUCTIBLE S — $ RETENTION $ $ S WORKERg COMPENSATION AND NC2920155 10/01/06 10/01(07 X WCSTATU- OTH- !-- _,_rC ST TU- —. C EMPLOYERS' LIABILITY NC2920158 10/01/06 10/01/07 E.L.EACH ACCIDENT $1 000,000 ANY PROPRIETOR/PARTNERrEXECUTIVE INC _ — D OFFICERIMEMBER EXCLUDED? EXC SEE ATTACK LIST 10/01/06 10/02/07 E.L.DISEASE-EA EMPLOYEE $1 000, 000 M yrm, ascrlbounder SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT _ 1$1,000,000 OTHER A Crime/Fidelity 7520572 10/01/06 20/02/07 Crime 11000,000 A Staffing R&D Cvg. iSSL9519899 10/01/06 10/01/07 ETA Occ./Agg. 51000,000 DESCRIPTION OF OPERATIONS LOCATIONS/VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS Location: 1016 - Ft. Collins, CO Type of Company: City Municipality Job Description: Clerical, administrative assistant, help setup stage props All insurance carriers shorn on this certificate have an A.M. Beet Ratia of ArXV unless otherwise noted. City of Fort Collins Jamae OrNeil Director of Purchasing P.O. Box 580 Collins, CO 50524 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER VIIILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO TOUT LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY IOND UPON THE INSURER ITS AGENTS OR AUTHORIZED REPRESENTATIVE 26 ®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. 25 SUPPLEMENT TO CERTIFICATE OF INSURANCE DA 09/ 8/06 NAME OF INSURED: Express Services, Inc. Additional Description of Operations/Remarks from Page 1: Addidonallnfonnation: Workers, Compensation Policy Schedule: Policies Effective: 10-1-06 Policies Expiration: 10-1-07 Co. No. Policy No. States Covered: D. NC2920157 AE,AL,AR,AZ,CO,CT,DC,DE,GA,EI,IA,ID,IL,IE,RS,RY,LA,NA,MD,MX,MI, MN,NO,MS,NT,NC,NE,NH,HJ,NM,NV,HY,OE,PA,SC,SD,TN,TS,DT,VA A. WC2920156 WI (ND,OH,WA,WV,WY Emp.Liab.only) a. WC2920155 CA E. NC2920159 TL C. NC2920158 OR SUPP (05104)