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405905 CORPORATE PROTECTIVE SERVICES - INSURANCE CERTIFICATE
ACORD CERTIFICATE OF LIABILITY INSURANCE TM. DAT12/W2006 ' PRODUCER Phone: (307) 634-5757 Fax: (307) 634-7236 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MAX B CARRE' ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BURNS INSURANCE AGENCY INC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1600 EAST 19TH STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CHEYENNE WY 82001 PHONE: 307-6345757 FAX: 307-8347236 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Big Sky Underwriters INSURERS: CORPORATE PROTECTIVE SERVICES INC PO BOX 588 CHEYENNE WY 82003 INSURER C: INSURER D: INSURER E: LKe�TL�:r;IH �7 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 LTR ADD I TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMID POLICY EXPIRATION DATE MMID LIMITS GENERAL LIABILITY CL250100355 11/09/06 11109/07 EACH OCCURRENCE $ 1,000,000 DAMAGE To RENTED PREMISES Ee acp,re $ 100 000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR MED. EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 A GENERAL AGGREGATE $ 2,000,000 GEICL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG. $ INCLUDED PRO- POLICV JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Par accident) $ PROPERTY DAMAGE $ rl Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EAACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE_ $ OCCUR ❑ CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC 57ATLL TORY LIMBS OTHER E.L. EACH ACCIDENT $ ANY PROPRIETORIPMTNERIEXECUTIVE E.L. DISEASE -EA EMPLOYEE $ OFFICERIMEMSER EXCLUDED? Ny",Mwrib.ondor SPECIAL PROVISIONS WI E.L. DISEASE -POLICY LIMIT $ OTHER: DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS The City of FL Collins is listed as an additional Insured on this policy. CITY OF FORT COLLINS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 215 N MASON ST EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE FT COLLINS, CO 80522 TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Attention: Max B Carre' ACORD 25 (2001108) Certificate # 17105 ©ACORD CORPORATION 1988