HomeMy WebLinkAboutDYNAMIC SYSTEMS - INSURANCE CERTIFICATEACORD,a CERTIFICATE
OF LIABILITY INSURANCE
04104/05°"""'
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
McQueary Henry Bowles Troy LLP
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
12700 Park Central Drive
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
17th Floor
Dallas, TX 75251-0470
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
INSURER A: American Guarantee & Llab
40142
Dynamic Systems Inc
INSURER B: Zurich American Ins. Co.
3901 S Lamar
INSURERC: St. Paul Surplus Lines Co
Suite 100
INSURER D:
Austin, TX 787040000
INSURER E:
rnvcwencc
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
:NSRE
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATM
POLICY EXPIRATION
DAT M
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE Fx_1 OCCUR
X Contractual
3437151
04/01/05
04/01/06
EACH OCCURRENCE
$1 000 000
DAMAGES ( RENTED
1500.000
MED EXP (Any one person)
$10 000
PERSONAL BADVINJURY
S1000000
Liability
GENERAL AGGREGATE
$2 000 000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY X JE0oiEl LOC
PRODUCTS - COMPIOP AGG
$2 000 000
A
B
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULEDAUTOS
HIREDAUTOS
NON -OWNED AUTOS
TAP3437153TX
BAP3437154
04/01/05
04/01/05
04/01/06
04/01/06
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
X
BODILY INJURY
(Per person)
$
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY -EA ACCIDENT
S
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
C
EXCESSIUMBRELLA LIABILITY
X OCCUR 71 CLAIMS MADE
DEDUCTIBLE
X RETENTION $ 10 000
OZO6825045
04/01/05
04/01/06
EACH OCCURRENCE
s5,000,000
AGGREGATE
$5 000 000
S
$
$
A
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED?
If yes, desc iba under
SPECIAL PROVISIONS below
3437152
04/01/05
04/01/06
X WC STATU- OTH-
E.L. EACH ACCIDENT
$1 000 000
E.L. DISEASE - EA EMPLOYEE
$1,000 000
E.L. DISEASE -POLICY LIMIT
$1 000 000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
RE: JOHN R. MARCHAND - SS#458-11-9361
City Of Fort Collins
281 North College Avenue
Fort Collins, CO 80522-0580
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL -In 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
ACORD 25 (2001/08) 1 of 2 #M50164 AYL W Awlcu cvllcrvnAnvn TNaa
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.
ACORD 25-S (2001108) 2 of 2 #M50164