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Home My WebLink AboutXEROX - INSURANCE CERTIFICATE............................................................................ CERTIFICATE NUMBER NYC•0W605802-04 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 601 MERRITT 7 POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE NORWALK, CT 06856 AFFORDED BY THE POLICIES DESCRIBED HEREIN. CHRISTINE KIMBELL/ FAX 203-229-6970 XEROX.CERTREQUEST@ MARSH.COM COMPANIES AFFORDING COVERAGE COMPANY J54000-XEROX-CAS-04-05 A ACE AMERICAN INSURANCE COMPANY INSURED XEROX CORPORATION AND ITS SUBSIDIARIES COMPANY 800 LONG RIDGE ROAD B STAMFORD, CT 06904 COMPANY C 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 (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A A A X GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR OWNER'S & CONTRACTOR'S PROT XSLG21690557(US) CGL 322548 (CANADA) 41-PR-0200325 (PH) GENERAL LIABILITY POLICY APPLIES EXCESS OF A $250,000 EACH OCC. SELF -INSURED RETENTION. 01/01/04 01/O"4 01/01X4 01/01/05 01/01/05 01/01/05 GENERAL AGGREGRATE $ 10,000,000 PRODUCTS-COMPlOP AGG INCLUDED ABOVE PERSONAL &ADV INJURY $ 1,750,000 EACH OCCURRENCE $ 1,750,000 FIRE DAMAGE (Any we fire) $ N/A MED EXP (Any me person) $ N/A A A A A X X AUTOMOBILE LIABILITY ANY ALTO ALL OWNED AUTOS SCHEOULEDAUTOS HIRED AUTOS NON-OWNEDAUTOS SELF INSURED COMPICOLL ISA HO 795997-7(AOS) CAC424333 (CANADA) 28-PRB200215(PH) 28-USB-3658(US VI) 01/01/04 01/01/04 01/01/04 01/01/04 01/01/05 01/01/05 01/01/05 01/01/05 COMBINED SINGLE LIMIT $ 2,000,000 BODILY INJURY (Per person) $ BODILY INJURY (per accident) $ PROPERTY DAMAGE $ GARAGE LIABILITY ANY AUTO AUTO ONLY -EA ACCIDENT $ OTHER THAN AUTO ONLY, EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ $ A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE OFFICERS ARE: EXCL WLRC4353657-6(ADS) SCFC4353728-3 (WI) ( 01/01/04 01/01/04 01/01/05 01/01/05 X TWC STATU- OTH ER EACTORH EL EACH ACCIDENT ACCIDENT $ 1 000,000 EL DISEASE -POLICY LIMIT $ 1,000,000 EL DISEASE -EACH EMPLOYEE $ 1,000.000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS CITY OF FORT COLLINS ATTN: JAMES B. O'NEILL 256 W. MOUNTAIN AVENUE P.O. BOX 580 FORT COLLINS, CO 80522.0580 SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE, ITS AGENTS OR REPRESENTATIVES, OR THE ISSUER OF THIS CERTIFICATE. MARSH USA INC BY: Connie Chi �111 A At. CAS._