HomeMy WebLinkAboutOPTIO SOFTWARE - INSURANCE CERTIFICATErlinnf f• 0007
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ACORDTM CERTIFICATE OF LIABILITY
INSURANCE
04/10107D"YYY)
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Wachovia Insurance Serv-AT, GA
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
4401 Northside Pkwy, Suite 400
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Atlanta, GA 30327-3078
770 850-0050
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
Optio Software, Inc.
3015 Windward Parkway;
Windward Fairways II
Alpharetta , GA 30005
INSURER A: Hartford Fire Insurance Company
19682
INSURER B: Hartford Casualty Insurance Company
29424
INSURER C:
INSURER 0-
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.
LTR
N R
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MMIDDLYYI
POLICY EXPIRATION
DATE (MMIDDIYY)
LIMITS
A
GENERAL LIABILITY
2000NUX4610
04/03/07
04/03/08
EACH OCCURRENCE
$1000000
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
$300 OOO
MED EXP (Any one person)
$1 O 000
CLAIMS MADE 51OCCUR
PERSONAL& ADV INJURY
$1 000 000
GENERAL AGGREGATE
$1 OOO 0O0
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$1 000000
PRO-
LOC POLICY
CT El
A
AUTOMOBILE
LIABILITY
ANY AUTO
2000NUX4610
04/03/07
04/03/08
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
0
$
AUTO ONLY: AGG
B
EXCESS/UMBRELLA LIABILITY
X OCCUR CLAIMS MADE
20RHUUX5493
04/03/07
04/03/08
EACH OCCURRENCE
$10 000 000
AGGREGATE
$1000O 000
DEDUCTIBLE
X RETENTION $ 1O 000
$ .
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
20WBGD6841
04/03/07
04103/08
X Wu STATU- oTH-
IER
E.L. EACH ACCIDENT
$500000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
E.L. DISEASE - EA EMPLOYEE
$SOD OOO
E.L. DISEASE- POLICY LIMIT 1$500,000
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Where required by written agreement, the Certificate Holder is included as
an Additional Insured under the General Liability insurance, but only for
work performed by or on behalf of the Named Insured.
City of Ft. Collins
Attn: James B. O'neill
215 North Mason Street
2nd Floor
P.O. Box 580
LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL A_ DAYS WRITTEN
E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
-E NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
AUTHORIZED REPRESENT TIV �s
For WIS by: �% f% %fte
—•-•- -�� •��, I Or c "I15Deunlv11lt{bbva DLS01 Q 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).
17��d�11u1
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.
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