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Home My WebLink AboutSTAFFSCAPE - INSURANCE CERTIFICATEACORQ. CERTIFICATE OF LIABILITY INSURANCE 9/28 M/DD YY) 09/28/07 PRODUCER 1-303-534-4567 IMA of Colorado, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 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 INSURER Pinnacol Assurance StaffScapee INSURER B INSURER 12000 Pecos St., Suite 300 INSURERD Westminster, CO 80234 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 INS. IT.GENERAL TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LIABILITY EACH OCCURRENCE $ FIRE DAMAGE (Any one fire) $ COMMERCIAL GENERAL LIABILITY MED EXP (Any one person $ CLAIMS MADE ❑OCCUR PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEN L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ POLICY PRO_LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NOWO WNED AUTOS BODILY INJURY (Per acatlent) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY AGG EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR CLAIMS MADE $ DEDUCTIBLE $ RETENTION $ A WORKERS COMPENSATION AND 4016179 10/01/07 10/D1/08 X WC BTI OFA E L EACH ACCIDENT $ 1,000,000 EMPLOYERS' LIABILITY EL DISEASE - EA EMPLOYEE $1,000,000 E L DISEASE. POLICY LIMIT S 1,000,000 OTHER 8 E E DESCRIPTION OF OPERATIONS/LOCATIONS EHICLEWUCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS This Certificate shows that HSH electric, Inc., 228 S Link Land, Port Collins, CO 80524 is covered under the Workers Compensation Policy issued to StaffScapee. of Port Collins Box 580 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 Port Collins, CO 80522-0000 USA 25-S(7/97) meganm 7158160 AUTHORIZED REPRESENTATIVE O AGUHU 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 (7/97)