HomeMy WebLinkAboutOPTIO SOFTWARE - INSURANCE CERTIFICATE (3)ACORD- CERTIFICATE
OF LIABILITY INSURANCE
DATE )
04/05/05D
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Wachovia Insurance Serv-AT, GA
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
4401 NOrthside Pkw ,Suite 400
Y
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Atlanta, GA 30327-3078
770 850-0050
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
INSURERA: Hartford Fire Insurance Company
19682
Optio Software, Inc.
INSURER B: Hartford Casualty Insurance Company
29424
3015 Windward Parkway
INSURERc: Twin City Fire Insurance Company
29459
Windward Fairways II
INSURER D:
Alpharetta, GA 30005
INSURER E:
rnvCMAcCQ
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.
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MM/DD
POLICY EXPIRATION
DATE MMIDD/YY
LIMITS
A
GENERAL LIABILITY
2000NUX4610
04/03/05
04/03/06
EACH OCCURRENCE
$1000000
DAMAGE TO RENTEDPREMISE (Ea occurrence)
$300 DDD
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE FX1 OCCUR
MED EXP (Any one person)
$1 D 000
PERSONAL &ADV INJURY
$1 00D 000
GENERAL AGGREGATE
$1 000 000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMP/OP AGG
$1 000000
POLICY PRO LOC
JECT
A
AUTOMOBILE
LIABILITY
ANY AUTO
2000NUX4610
04/03/05
04/03106
COMBINED SINGLE LIMIT
(Ea accident)
$1 DOD ODD
r r
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
BODILY INJURY
(Per accident)
$
HIREDAUTOS
NON -OWNED AUTOS
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTOONLY: AGG
B
EXCESSIUMBRELLALIABILITY
20RHUUX5493
04/03/05
04/03/06
EACH OCCURRENCE
$10000000
X1 OCCUR CLAIMS MADE
AGGREGATE
$1 O 00O 000
$
DEDUCTIBLE
$
X RETENTION $ 1D 000
C
WORKERS COMPENSATION AND
20WBGD6841
04/03/05
04I03/06
X WC STATU- OTH-
RY EB-
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$500,000
E.L. DISEASE - EA EMPLOYEE
$500,000
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
I
E.L. DISEASE - POLICY LIMIT
$500,000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Certificate Holder is Included as Additional Insured as respects General
Liability Coverage, but only for work performed by or
on behalf of the Named Insured.
City of Ft. Collins
Attn: James B. O'neill
215 North Mason Street
2nd Floor;P.O. Box 580
Fort Collins, CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL A0._ 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 REPRESEN TIV
For WIS by: V-�/d ;err
ACORD 25 (2001108) 1 of 2 #S622721/M622717 DLS01 0 ACORD CORPORATION 1988
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.
AWKD 25.5 (Z007/08) 2 of 2 #S6227211M622717