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HomeMy WebLinkAboutOPTIO SOFTWARE - INSURANCE CERTIFICATE (5)ACORD,M CERTIFICATE OF LIABILITY INSURANCE 04/14104 DATE YYYI) — - 04 Wachovia Insurance Serv-AT, GA 4401 Northside Pkwy, Suite 400 Atlanta, GA 30327-3078 770 850-0050 INSURED Optio Software, Inc. 3015 Windward Parkway; Windward Fairways If Alpharetta, GA 30005 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 NAIC # INSURERA: Hartford Fire Insurance Company 19682 INSURER B. Hartford Casualty Insurance Company 29424 INSURERc: Twin City Fire Insurance Company 29459 INSURER D: INSURER E: 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. INSR LTR ADD' INSRN TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE MWDDIYY POLICY EXPIRATIONDATE DATE MINDD/YYI LIMITS A GENERAL LIABILITY 2000NUX4610 04/03/04 04/03/05 EACH OCCURRENCE $1 00U 000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE FX OCCUR DAMAPREmiGE TO RENTED $3DD OOD MED EXP (Any one person) $10 000 PERSONAL & ADV INJURY $1 00D 000 GENERAL AGGREGATE $1 00Q 000 GEN'L AGGREGATE LIMITAPPLIES PER: POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $1000000 A AUTOMOBILE LIABILITY ANY AUTO 2000NUX4610 04/03/04 04/03/05 COMBINED SINGLE LIMIT (Ea accident) a1,OUD,OUD ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIREDAUTOS NON -OWNED AUTOS X BODILY (Per accident)dent) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG B EXCESS/UMBRELLA LIABILITY X1 OCCUR CLAIMS MADE 20RHUUX5493 04/03/04 04/03/05 EACH OCCURRENCE $10 000 000 AGGREGATE $10 00D 000 $ DEDUCTIBLE X RETENTION $ 1 D 000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITYLIMIT 20WBGD6841 04103l04 04/03/05 X WC STATU• OTH- E.L. EACH ACCIDENT s500 OOO ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? If yes, describe under E.L. DISEASE -EA EMPLOYE $SUD,ODD E.L. DISEASE - POLICY LIMIT $500,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS Certificate Holder is included as Additional Insured as respects General Liability Coverage, but only for work performed by or on behalf of the Named Insured. City of Ft. Collins Attn: James B. O'neill 215 North Mason Street 2nd Floor;P.O. Box 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL -1A0_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE�. For WIS by: /© %4r I vl 4 RTS01 0 ACCIRD CORPORATION 1988 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. ^��^� ��� �.....••...,� Z or Z rFbZU1Zti61MZ61Z63