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HomeMy WebLinkAbout125038 H AND H DATA SERVICES INC - INSURANCE CERTIFICATE (2)P, 01 MAR-12-2003 WED 02:49 PM DIVERSIFIED INSURANCE BR FAX NO. 8015322804 AGO--qD- CERTIFICATE OF LIABILITY INSURANCE Diversified Insurance Brokers of Utah 1.36 E. South Temple, Ste 2300 alt Lake City UT 84111 Phone:801-325-5000 Fax:601-532-2804 H G H Data Services Inc. c/O ROSOUreg One, LLC q a: TerraFirma 1310 Webster Avenue Fort Collins CO 80524 ONLY AND CONFERS NO RK HOLDER. THIS CERTIFICATE ALTER THE COVERAGE AFF 'INSURERS AFFORDING COVERAGE INSURER A• Pinnacol Assura INSURER C. INSURER D: oP 10 8 SATE p 4100" ) CSOU-4 03,1z 03 ITTER OF MIFORMAT I)N )N THE CERTIFICATI: DT AMEND, EXTEND - )R IY THE POLICIES BE .OW. NAV : THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEO TO THE INSURED HA.IAED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT VRTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 16 SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. ACGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ INSRR ADanO' TYPE OF INSURANCE POUCV NUMBER •~—_ DATE MMIDD DAOqlm"Z)LMARS GENERAL LIABILITY EACH OCCURRENCE 6 PREMISES JEA ACCwMCA 6 COIAMERCUL GENERAL LABILITY MED EXP IAAY W* PM ) f CLAIMS MADE n OCCUR : PERSONAL A ADV INJURY S ! GENERAL AGGREGATE 6 GENL AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMPIOPAGG 6 _----- ___ ! {pgypp POLICY JEOT F7 LOC III AUTOMOBILE •- LIABILITY ANYAUTO COMBINED SINGLE LIMIT (Es ACmFAM) �.._.... 6 ..,. _.:,...... ALL OWNED AUTOS BODILY INJURY S SCHEDULED AUTOS MAW AUTOS NON -OWNED AUTOS BODILY INJURY (Pa. �Fenl) 6 PROPERTY DAMAGE (PAr xcloAm) 6 GARAGE LIABILITY AUTO ONLY -EA ACCIDENT S 6 6 ANY AUTO i OTHERTHAN EA ACC AUTO ONLY: AGG EXCESSNMBRELLALUUMLITY EACHOCCURRENCE S S OCCUR CLAIMS MADE AGGREGATE 6 DEDUCTIBLE 6 RETENTIONTKTT WORKERS COMPENSATION AND X. TORY'LIMITS ER ....._....:.. .___....__._ E L_E.ACH ACCIDBHT E.L. DISEASE • EA cwwyEE A EMPLOYER* LIABILITY ANY PROPRIETORIPARTMERfEXECUTIVE OFFICERIMEMBER EXCLUDED7 4038719 01/01/03 01�01�041. 5100:000 S 100 . 000 _ EI. DISEASE POLICY LWT 6100.000 u bl y�A. E*W" ear SPECIAL PROVISIONS b0z. OTHER DESCRIPTION Of OPERATIONS I LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS This policy Covers employees for this customer that are handled by Resource One, LLC dba: TerraFirma. CERTIFICATE HOLDER CITFORT City of Fort Collins PO Box 580 Ft. Collins CO 80522-0590 iFLRY G4F/I � IVn SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE' IF EXPIRATION DATE THEREOF, THE ISSUING IN6URER WILL ENDEAVOR TO MAIL 30 D,YSWRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TC "80 SMALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS GENTS OR R" 6 NTATVE6• �B qE►RESENTATIVE ® ACORD CORPO ATION 1986