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HomeMy WebLinkAboutEXPRESS SERVICES - INSURANCE CERTIFICATE (7)ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID M DATE(MMIDDIYYYY) EXPRE-1 09 29 04 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Gallagher Bryce HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P O Box 3142 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Tulsa OK 74101 Phone:918-584-1433 Fax:918-582-1329 INSURED Express Services, Inc. 8516 NW Expresswa Oklahoma City OK 73162 wVLHAFjt s INSURERS AFFORDING COVERAGE NAIC # INSURERA: National Union Fire Ina Co of INSURERS: American Home Assurance Cc INSURERC: Illinois National Ins Cc INSURER D: American International South 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. POLICY EFFECTIVE POLICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDDIYY DATE MMIDDIYV LIMITS I GENERAL LIABILITY,i I EACH OCCURRENCE $ 1 000 OOO [_ —t A X COMMERCIAL E GENERAL LIABILITY SSL9518899 10/Ol/04 10/O1/05 DAMAGFTURENTEDi t—_ PREMISES (Ea occuren.250,000 ce �$ CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5 1000 Staffln SeTV1Ce9 PERSONAL BADVINJURY $ Incl. E60 GENERAL AGGREGATE $2,000,000 _ _.. APPLIES —__I _ — $Included PRODUCTS COMP/OPAGG XEN'LPOLICYAGGREGAT JECT PRO- OC: _ _ AUTOMOBILE LIABILITY A ANY AUTO SSL9518899 10/01/04 10/01/05 COMBINED SINGLE LIMIT i (Ea accident) $ 1 000 D 00 r i ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIREDAUTOS BODILY INJURY $ X NON -OWNED AUTOS Per accident — PROPERTY DAMAGE $ (Per accident) I GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHERTHAN EA ACC I$ $ AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ 5 , 000 , 000 A X OCCUR CLAIMS MADE , BE3479560 10/01/04 10/01/05 _AGGREGATE $ 5,p00LQQp DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WCbi A - B EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE WC5898755 10/01/04 10/01/05 X. TORY LIMITS ER_ E.L. EACH ACCIDENT $1 Q00,000 OFFICER/MEe EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1 00O 000 and S yECIAL SPECIAL E.L. DISEASE -POLICY LIMIT $ 1,000,000 PROVISIONS below PROVISIONS OTHER A Crime/Fidelity 7144604 10/01/04 10/01/05 Crime 1,000,000 A Staffing E60 Cv . iSSL9518899 1 10/01/04 10/01/05 ESO Oc/Ag 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS *AL,AR,CO,IA,KS,KY,ME,MO,MS,MT,NC,NH,NJ,NM,OK,SC,SD,TX,UT Location:1016-Ft.Collins,CO; Type of Company: City Municipality; Job Description: Clerical, administrative assistant. All insurance carriers shown on this certificate have an A.M. Best Rating of A++XV unless otherwise noted. CITYFCI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN City of Fort Collins NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Attn: James O'Neill P.O. BOX 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Fort Collins, CO 80524 REPRESENTATIVES. ACORD 25 (2001/08) © ACORD CORPORATION 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 (2001108) ___ -.. , ..... �.� Workers Compensation Policy Schedule Continued: Policies Effective: 10-1-04 Policies Expiration: 10-1-05 F. AI9 Birmingham Fire Ins. Co. Co. No. Policy Number: State: B. WC5898759 B• WC5898758 A• WC5898761 C. WC5898757 D. WC5898760 E. WC5898756 F. WC5898808 B. WC5898843 CA MN WI and Monopolistic Emp. Liab. CT, FL, IL, IN, LA, MI, NY, PA GA AZ, ID, MA, MD, TN, VA OR NV