HomeMy WebLinkAboutQWEST GOVERNMENT SERVICES - INSURANCE CERTIFICATEA
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==411 11 s ,yL,i °,'� pis t.n., tk_ .{L�=e s .f •4r 't SEA-000259186-02
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
MARSH USA INC
NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
THE FINANCIAL CENTER
POLICY THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
1215 FOURTH AVENUE, SUITE 2300
AFFORDED BY THE POLICIES DESCRIBED HEREIN
SEATTLE, WA 98161-1095
Attn Kathy Hann 206 613-2625 Fax 206 613-2516
COMPANIES AFFORDING COVERAGE
COMPANY
100499-QGS-GAW-07-08, kbh cent none
A NATIONAL UNION FIRE INS CO OF PA
INSURED:. •• v
COMPANY I
QWEST GOVERNMENT SERVICES, INC
B INSURANCE COMPANY OF THE STATE OF PA
1801 CALIFORNIA STREET, SUITE 1150
- -
DENVER, CO 80202
COMPANY
C AMERICAN HOME ASSURANCE COMPANY
COMPANY
D
,COVERAGES 1 t 7 4' , ., ,,, • • I •t r „`• r n•Tv ,u•, m s,n 1 HMI .ap, wH 1 t o 4t vie µ,i ii^+ p ITS• AY A i
)'tl {mil ,au �i*I� � I P ,1,Tha'ceiTli:cate supersedeswa'rid'replaces'any,prevlously Is -'sued certificate for -,the;pohcgp'enod noted below � �" �12 -�{,yf
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED
NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS CONDITIONS AND EXCLUSIONS OF SUCH POLICIES AGGREGATE
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE(MMIDDNY)
POUCY EXPIRATION
DATE(MMIDDNY)
UNITS
A
GENERAL LIABILITY
GL1595519
10/01/07
10/01/08
GENERAL AGGREGATE
$ 1,000,000
PRODUCTS-COMP/OP AGG
$ 1,000,000
X COMMERCIAL GENERAL LIABILITY
`4 �) CLAIMS MADE � OCCUR
PERSONAL & ADV INJURY
$ 1,000,000
EACH OCCURRENCE
$ 1,000,000
OWNER S B CONTRACTOR'S PROT
FIRE DAMAGE (My me fire)
$ 1,000,000
MED EXP weperson)
$ 10,000
A
AUTOMOBILE
LIABILITY
CAI 607086(ADS)
10/01/07
10/01/08
COMBINED SINGLE LIMIT
$ 1,000,000
X
A
ANY AUTO
CAI607087 (CT, LA)
10/01/07
10/01/08
BODILY INJURY
$
G
ALL OWNED AUTOS
CAT 607088(MA)
10/01/07
10/01/08
A
SCHEDULED AUTOS
CA1607089(VA)
10/01/07
10/01/08
(Per person)
X
BODILY INJURY
(Per Deadens)
$
HI q ED AUTOS
NON OWNED AUTOS
J
X
PROPERTY DAMAGE
$
SELF -INSURED FOR
UTO PHYSICAL DAMAGE
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
OTHER THAN AUTO ONLY
hy— -'�. 1
" 9, W" F'W'�I Lu � =E+i11'll
EACH ACCIDENT
$
AGGREGATE
$
EXCESS UABIUTY
EACH OCCURRENCE
$
AGGREGATE
$
UMBRELLA FORM
$
OTHER THAN UMBRELLA FORM
B
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
WC5455528(AOS)
WC5455529(CA)
10/01/07
10/01/07
10/01/08
10/01/08
X TORY LIMITS ER
}
'�`Ct,;ir,I"asht',{i
--
EL EACH ACCIDENT
$ 1.000,000
EL DISEASE POLICY LIMIT
$ 1,000,000
B
A
THE PROPRIETOR/ INCL
SAREcunvE
PARTNER OFFICERS
OFFICERS ARE EXCL
WC5455530(FL)
WC5455531 OR
( )
10/01/07
10/01/07
10/01/08
10/01/08
EL DISEASE EACH EMPLOYEE
$ 1,000,000
THEN
B
Workers' Compensation
WC5455532 (TX)
10/01/07
10/01/08
Each Accident/Employee $1,000,000
A
Workers' Compensation
WC5455533 (WI ND OH WV WY)
10/01/07
10/01/08
Each Accident/Employee $1,000,000
C
Excess Workers' Compensation
XWC5455534 (WA)
10/01/07
10/01/08
Excess of SIR Shown Above $1,000,000
DESCRIPTION OF OPERATIONSA.00ATIONSNEHICLESISPECIAL ITEMS
RE P871 Renewal 2007 Service agreement to provide maintenance of equipment & software for customer -provided equipment at various building locations
The City of Fort Collins, its officers, agents & employees are Additional Insureds as required by written contract on the General Liability Policy with respect to
referenced service agreement
CERTIFICATE HOLDER-- ', L`t " xl t' ;u11 i t +gi I� i,
.lit.w:LunL:Gi:.1LLL!'L'MY2,..iL.1¢FWaaa' 4 � u'�u!. I kn"",'`"EVE ' i . ; ..
C AN C ELL-ATION�*'E' F1;�f�"'r'�'K""� t��
i, 1J_ CiffiB�•I" u' i n, mil';a , �< <-L
SHOULD MY OF THE POLICIES DESCRIBED HEREIN BE CANCEILED BEFORE THE EXPIRATION DATE THEREOF
THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL _3D DAYS WRITTEN NOTICE TO THE
City of Fort Collins Purchasing
215 North Mason, 2nd Floor
P O Box 580
CERTIFICATE HOLDER NAMED HEREIN BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE ITS AGENTS OR REPRESENTATIVES OR THE
Fort Collins, CO 80522
ISSUER OF THIS CERTFICATE
MARSH USA INC //
BY Cheryll L Koch dilU4y _ �j ,Wd,,—
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MM1(3102)'fi,l' K: 'tp(r{ ,'t iI VALID AS OF r09/26/07 Ey1
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