HomeMy WebLinkAboutQWEST INTERPRISE - INSURANCE CERTIFICATE (2)CERTIFICATE NUMBER
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SEA-000659690-07
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 4th Avenue
AFFORDED BY THE POLICIES DESCRIBED HEREIN.
Suite
Seattlee,, WWA 98161-1095 A
COMPANIES AFFORDING COVERAGE
COMPANY
Attn: Kathy B. Harid 206 613-2625 Fax: 206 613-2516
00535-QIA-GAW-05-06 kbh 040206 none
A NATIONAL UNION FIRE INS CO OF PA
INSURED
COMPANY
QWEST INTERPRISE AMERICA, INC.
1801 CALIFORNIA STREET, SUITE 1150
B INSURANCE COMPANY OF THE STATE OF PA
COMPANY
DENVER, CO 80202
C AMERICAN HOME ASSURANCE COMPANY
COMPANY
D
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 (MMIDDIYY)
POLICY EXPIRATION
DATE (MMIDDIYY)
LIMITS
A
GENERALUABILITY
GL6051488 04/01/05
04/01/06
GENERAL AGGREGATE
$ 1,000,000
X
PRODUCTS-COMP/OP AGG
$ 1,000,000
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 1K OCCUR
PERSONAL& ADV INJURY
$ 1,000,000
EACH OCCURRENCE
$ 1,000,000
OWNER'S& CONTRACTOR'S PROT
FIRE DAMAGE (Any one fire)
$ 1,000,000
MED EXP (Any mePerson)
$ 5,000
A
A
AUTOMOBILE
LIABILITY
ANY AUTO
CA2053350 (AOS) 04/01/05
CA2053349 (TX) 04/01/05
04/01/06
04/01/06
COMBINED SINGLE LIMIT
$ 1,000,000
X
A
ALL OWNED AUTOS
SCHEDULED AUTOS
CA2053348(VA) 04/01/05
04/01/06
BODILY INJURY
(Per Person)
$
HIREDAUTOS
NON -OWNED AUTOS
X
BODILY INJURY
(Per accident)
$
X
ELF -INSURED FOR
X
PROPERTY DAMAGE
$
UTO PHYSICAL DAMAGE
GARAGE LIABILITY
AUTO ONLY -EA ACCIDENT
$
ANY AUTO
OTHER THAN AUTO ONLY:
EACH ACCIDENT
$
AGGREGATE
$
EXCESS LIABILITY
EACH OCCURRENCE
$
AGGREGATE
$
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
$
A
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
WC5899586 (AOS) 04/01/05
WC5899585(CA) 04/01/05
04/01/06
04/01/06
X TORY LIMITS ERyI'+
ELEACIACCIDENT
$ 1000,000
A
A
THE PROPRIETOR/ INCL
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL
WC5899588 (ND OH WI WV WY) 04/01/05
WC5899597(OR) 04/01/05
O4/O1/O6
04/01/06
EL DISEASE -POLICY LIMIT
$ 1,000,000
EL DISEASE -EACH EMPLOYEE
$ 1,000,000
OTHER
C
Excess Workers' Compensation
WC5899589 (WA) 04/01/05
04/01/06
SIR Each AccidenUEmployee $1,000,000
Excess of SIR Shown Above $1,000,000
DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESISPECIAL ITEMS
RE: Backup for City on Norte[ equipment maintenance (4/2/05 to 4/2/06). The City, its officers, agents and employees are Additional Insureds as respects
their interest in the operations of the Named Insured as required by written contract regarding General Liability.
—
i..` , - ,_. �'y—,.31 M1£?tx I -.
.. W " _" i:�,.i $ — n•'2 •i{ 3:t =.-4! i k, i
SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF
City of Fort Collins
Attn:Jeri Mael
THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 'A DAYS WRITTEN NOTICE TO THE
CERTIFICATE HOLDER NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
PO BOX 580
Fort Collins, CO 80522
LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE, ITS AGENTS OR REPRESENTATIVES. OR THE
ISSUER OF THIS CERTIFICATE.
MARSH USA INC.
BY: Cheryl) L. Koch U444L'7j
s; ° - • • . ,.
': + ' , + :' _` „ VALID AS OF: `03/30/05