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Home My WebLink AboutEMPLOYER SERVICES GROUP - INSURANCE CERTIFICATEA R CERTIFICATE OF LIABILITY INSURANCE 3/01/3/O1/0DW"") 07 PRODUCER 1-303-534-4567 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The INA Financial Group, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE INA of Colorado, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1550 17th Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 600 Denver, CO 80202 INSURERS AFFORDING COVERAGE INSURED Employer Services Group LLC INSURER A: Pinnacol Assurance INSURER B: 7000 E. Belleview Avenue Suite 290 INSURER C: Greenwood Village, CO 80111 VNSURER D: INSURER E: COVERAGES 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 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE IMU(DDTM POLICY EXPIRATIONDATE DATE (MMIDOMI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ FIRE DAMAGE (Any one tire) $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE DOCCUR MED EXP (Any oneperson) $ PERSONAL B ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-CAMP/OP AGG $ POLICY PRO- LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTYDAMAGE (Per accident) $ ri GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ A WORKERS COMPENSATION ANDEEL 4027173 03/01/07 03/01/08 X T&CYITAI LIMIT OTH- EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $1,000,000 OTHER E S S DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS This Certificate shows that T2 Technologies, Inc., 5595 S. Caprice St , Littleton, CO 80120 is covered under the Workers Compensation Policy issued to Employer Services Group LLC. CERTIFICATE MnLnFR I I anmmnwar nasuRFn. rRRuwcR i t FR- CANCFI I ATIAN 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 300 La Porte Ave. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Fort Collins, CO 80521 USA ACORD 25-S (7197) millshae ® ACORD CORPORATION 1988 5745743 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. 9 SHELTER INSURANCE COMPANIES 1817 WEST BROADWAY COLUMBIA, MISSOURI 65218-0001 ��® 1-800-SHELTER 001625 ODECO22807 — #003561297 CITY OF FORT COLLINS PO BOX 580 FORT COLLINS CO 80522-0580 u�r��uu�r�nr�r�u�r��nu�r�r�u�r��ur�u�r��nur�r POLICY NUMBER: 05-31-003561297-0003 Page i