HomeMy WebLinkAboutFOUNDERS BUSINESS SERVICES AMCHECK - INSURANCE CERTIFICATEL ACORQti CERTIFICATE OF LIABILITY INSURANCE o5/03/0 °'"""'
PRODUCER 1-303-534-4567 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
The INA Financial Group, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
INA of Colorado, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1550 17th Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 600
Denver, Co 80202 INSURERS AFFORDING COVERAGE
INSURED
Founders Business Services LLC dba AmCheck
1799 Pennsylvania Street
, CO 80203
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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.
WSR
jJ&DATE
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
(MMIDD8M
POLICY EXPIRATION
DATE (MMIDOMI
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$
FIRE DAMAGE (Anyone fire)
$
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE1:1 OCCUR
MED EXP tAny one person)
$
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMP/OP AGG
$
PRO LOC
POLICY jFrT
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESS LIABILITY
EACH OCCURRENCE
$
OCCUR CLAIMS MADE
AGGREGATE
$
$
DEDUCTIBLE
$
RETENTION $
A
WORKERS COMPENSATION AND
4044899
06/01/04
06/01/05
g WC STATU- OTHR
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
$ 100, 000
E.L. DISEASE -EA EMPLOYEE
$ 100,000
E.L DISEASE -POLICY LIMIT
$500,000
OTHER
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DESCRIPTION OF OPERATIONSILOCATONS(VEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
This Certificate shows that Hydro -Dynamic Services, L.L.C., 2207 Lake Ave., Eastlake, CO 80614 is covered under the
Workers Compensation Policy issued to Founders Business Services LLC dba AmCheck.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Fort Collins DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Po Box 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE�a
USA 1�
ACORD 25-S (7197) charliel m ACORD CORPORATION 1988
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PDWered ByCertfrcatesNowTM
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.
(7/97)