HomeMy WebLinkAboutEXPRESS SERVICES INC - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE EXPOf RE M DATE (MMIDD/04
RE-1 09 29 04
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Gallagher Bryce HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P O Box 3142 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tulsa OK 74101
Phone:918-584-1433 Fax:918-582-1329
INSURED
Exxppress Services, Inc.
8516 NW Express'%162
Oklahoma C-Ity OK
COVERAGES
INSURERS AFFORDING COVERAGE NAIC #
INSURERA: National Union Fire Ins Cc of
INSURERB: American Home Assurance Co
INSURERC: Illinois National Ins Co
INSURER D: American International South
INSURER E: Ins Cc of the State of PA
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.
POLICY!� POLICY NUMBER DATE MMIDDIYY DATE MMIDDIYY LIMITS
LTR NSR TYPE OF INSURANCE DATE( MIDDIYY) POLICY EXPIRATION
GENERAL LIABILITY
II,
EACH OCCURRENCE
1 $ 11000 000_
A j
X COMMERCIAL GENERAL LIABILITY
SSL9518899
10/01/04 10/01/05
$250,000
_. -.
PREMISES
CLAIMS MADE OCCUR
$ 5 000
MED EXP (Any one person)
$ Incl. E&O
Staffing Services
PERSONAL & ADV INJURY
GENERAL AGGREGATE
$ 2 000 000
N'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ Included
X I POLICY. PRO- LOC
JECT
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
$ 1 000 000
A
ANY AUTO SSL9518899 10/01/04
10/01/05
(EaCO accident)
r r
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per person)
$
X
HIREDAUTOS
BODILY INJURY
$-
X
NON -OWNED AUTOS
(Per accident)
----
----- --
PROPERTY DAMAGE
$
(Per accident)
GARAGE
LIABILITY
AUTO ONLY -EA ACCIDENT
$
OTHER THAN EA ACC
$ __.-.
ANY AUTO
AUTO ONLY: AGG
$
EXCESSIUMBRELLA LIABILITY
EACH OCCURRENCE
s5,000,000
A
X 1OCCUR CLAIMS MADE
BE3479560 10/01/04 1 10/01/05 AGGREGATE
$5 000,000
DEDUCTIBLE
RETENTION $
$
WORKERS COMPENSATION AND
X__ TORY LIMITS ER
B
EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
WC5898755 (*)
10/01/04 10/01/05,.
E.L. EACH ACCIDENT -_
-
$ 11000 000
OFFICER/MEMBER EXCLUDED?
E.L. DISEASE - EA EMPLOYEEI
$I1,000,000
descunder
E.L. DISEASE -POLICY LIMIT
$ 1 000 000
SPECIfes
AL PrROVISIONS below
OTHER
A
Crime/Fidelity
7144604
10/01/04
10/01/05
Crime 1,000,000
A
Staffing E&O Cv .
SSL9518899
10/01/04
10/01/05
E&O Oc/Ag 2,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
*AL,AR,CO,IA,KS,KY,ME,MO,MS,MT,NC,NH,NJ,NM,OK,SC,SD,TX,UT
Location:1016-Ft.Collins,CO; Type of Company: City Municipality; Job
Description: Clerical, administrative assistant. All insurance carriers
shown on this certificate have an A.M. Best Rating of A++XV unless otherwise
noted.
CITYFCl SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOP
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
City of Fort Collins NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Attn: James O'Neill
P.O. Box 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Fort Collins, CO 80524 REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2001/08)
0 ACORD
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.
AGUKU Z* (ZUUI/Ut3)
Workers Compensation Policy Schedule Continued:
Policies Effective: 10-1-04 Policies Expiration: 10-1-05
F. AI9 Birmingham Fire Ins. Co.
Co. No. Policy Number: State:
B. WC5898759 CA
B. WC5898758 MN
A. WC5898761 WI and Monopolistic Emp. Liab.
C. WC5898757 CT, FL, IL, IN, LA, MI, NY, PA
D. WC5898760 GA
E. WC5898756 AZ, ID, MA, MD, TN, VA
F. WC5898808 OR
B. WC5898843 NV