HomeMy WebLinkAboutEMPLOYER SERVICES GROUP - INSURANCE CERTIFICATE (2)A R 03/O1/07 CERTIFICATE OF LIABILITY INSURANCE DATE/07 /YY)
PRODUCER 1-303-534-4567 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
The IMA Financial Group, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
IMA of Colorado, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1550 17th Street
Suite 600
Denver, CO 80202
INSURED
Services Group LLC
000 E. Belleview Avenue
cite 290
Village, CO 80111
INSURERS AFFORDING COVERAGE
An
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.
ILTR NSR
TYPE OF INSURANCE
POLICY NUMBER
new IMMIDDIM POLICY EFFECTIVE
POLICY EXPIRATION
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$
FIRE DAMAGE (Any one fire)
$
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE F1 OCCUR
MED EXP (Any one person)
$
PERSONAL d ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO-
JECTLOC
PRODUCTS-COMP/OP AGG
$
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea ecciderd)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per person)
$
HIRED AUTOS
NON-0WNED AUTOS
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
GAR AGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESS LIABILITY
EACHOCCURRENCE
$
AGGREGATE
$
OCCUR CLAIMS MADE
DEDUCTIBLE
$
RETENTION $
A
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
4027173
03/01/07
03/01/08
X I WC STATU- I OTH-
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEJ
$1,000,000
E.L. DISEASE -POLICY LIMIT I
$1, 000, 000
OTHER
s
E
E
DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
This Certificate shown that T2 Technologies, Inc., 5595 S. Caprice St , Littleton, CO 80120 is covered under
the Workers Compensation Policy issued to Employer Services Group LLC.
(City of Fort Collins
300 La Porte Ave.
Port Collins, CO 80521
1
ACORD 25-S (7/97) millahae
5745743
USA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
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
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
AUTHORIZED REPRESENTATIVE
Cc7_GiiT:Ti'
G Gr:T;I
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-S
NSHELTER INSURANCE COMPANIES
1817 WEST BROADWAY
COLUMBIA, MISSOURI 65218-0001
�� ® 1-800SHELTER
001625 ODECO22807
#003561297
CITY OF FORT COLLINS
PO BOX 580
FORT COLLINS CO 80522-0580
POLICY NUMBER: 05-31-003561297-0003
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