HomeMy WebLinkAboutCORRESPONDENCE - GENERAL CORRESPONDENCE - P914 TELEWORK INSURANCE CERTIFICATEACORD. CERTIFICATE OF LIABILITY INSURANCE
0DATE (MM/DDNY)
1/06/2004
PRODUCER (818)881-8900 FAX (818)881-8922
Wheatman Insurance Services LLC
License #OC36866
6345 Balboa Blvd., Suite 285
Encino, CA 91316
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
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
INSURED ELHAM SHIRAZI
6215 DREXEL AVENUE
LOS ANGELES, CA 90048
INSURER A: Hartford Casualty Ins. Co.
INSURER B:
INSURER C:
INSURER 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.
INS R
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE fMMIDD1YY1
POLICY EXPIRATIONLTR
DATE fMMIDDfYY1
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE a OCCUR
72SBAKSO464
10/05/2003
10/05/2004
EACH OCCURRENCE
$ 1,000,000
FIRE DAMAGE (Any one fire)
$ 300,000
MED EXP (Anyone Person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
POLICY PRO LOC
JECT
PRODUCTS - COMPIOP AGG
$ 2,000,000
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
72SBAKSO464
10/05/2003
10/05/2004
COMBINED SINGLE LIMB
(Ea accident)
$ 1,000,000
BODILY INJURY
(Per Person)
$
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
rl
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
EXCESS LIABILITY
OCCUR O CLAIMS MADE
DEDUCTIBLE
RETENTION $
EACH OCCURRENCE
$
AGGREGATE
$
$
$
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
TORY LIMITS ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
$
OTHER
OPSCRIPTION OF OPERATIONnOCATIONSIVEHICLESIEXCLUSIONS ADDED 13Y ENDORSEMENT/SPECIAL PROVISIONS
,ty of Fort Collins is Included as Additional Insured as respects the operations of the Named
Insured. *10 Days Notice of Cancellation for Non -Payment of Premium.
CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
City of Fort Collins 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Attn: James B. O'Neil II
215 N . Mason Street BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
2nd Floor OF ANY VNID UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
Fort Collins, CO 80524 AUTHORIZE EPRE7 T I E
Judi
FAX: C970)221-6707 /