HomeMy WebLinkAbout125038 H AND H DATA SERVICES INC - INSURANCE CERTIFICATE (3)CERTIFICATE OF LIABILITY INSURANCE DATE (MhVDDIYYYy)
HHELE LE-1 07/30/03
ACORD
PRODUCER
Front Range Insurance Group
1109 Oak Park Drive Suite 101
Fort Collins CO 80525
r ze:970-223-1804
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H & H Data Services
Joe Hehn
1310 Webster Avenue
Fort Collins CO 80524
COVERAGES
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE I NAIC #
INSURER A: Trinity universal Insurance
INSURER B:
INSURER C:
INSURER D:
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
NSRtl
TYPE OF INSURANCE
POLICY NUMBER
DATE MMID
DATE MMIEXPIDD/YY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE FX7 OCCUR
CPA 4966560 05
07/01/03
07/01/04
EACH OCCURRENCE
-DAMAGE
$1,000,000
I V REM E.
PREMISES (Ea occurence
$100,000
MED EXP (Any one person)
$ 51000
PERSONAL B ADV INJURY
$ 1, 000, 000
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
17 POLICY 7 JEtT LOC
PRODUCTS-COMP/OP AGG
$2,000,000
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIREDAUTOS
NON -OWNED AUTOS
CPA 4966560 05
07/01/03
07/01/04
COMBINED SINGLE LIMIT
(En accident)
$ 1, 000, 000
BODILY INJURY
(Per person)
$
X
X
BODILY INJURY
(Per accident)
$
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
A
EXCESS/UMBRELLA LIABILITY
X OCCUR CLAIMSMADE
DEDUCTIBLE
X RETENTION $ 10, 000
DO 1762508-05
07/01/03
07/01/04
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$
$
$
WORKERS COMPENSATION AND
EMPLOYERS'LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
TORY LIMITS I I ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYE
$
E.L. DISEASE - POLICY LIMIT
$
A
A
OTHER
Equipment Floater
Property Section
CPA 4966560 05
CPA 4966560 05
07/01/03
07/01/03
07/01/04
07/01/04
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Fax: 484-3252 City of Fort Collins is listed as additional insured.
CERTIFICATE HOLDER
FORTC-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
City of Fort Collins IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P.O. Box 580
Fort Collins CO 80522-0580 REPRESENTATIVES.
ACORD 25 (2001/08)
COR