HomeMy WebLinkAboutEXPRESS SERVICES - INSURANCE CERTIFICATE (8)acoRv CERTIFICATE OF LIABILITY INSURANCE pplD DATE (MMIDD/03
EXPRE-1 09 30 03
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 Expressway
Oklahoma City OK 73162
INSURERS AFFORDING COVERAGE
INSURER A: National Union Fire Ins Co of
INSURER B: American Home Assurance Co
INSURERC: Illinois National Ins Co
INSURER D: American International South
NAIC #
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
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MMIDDM'
POLICY EXPIRATION
DATE MMIDDIYY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1 000 000
A
X COMMERCIAL GENERAL LIABILITY
SSL9518899
10/01/03
10/01/04
PRE�AEWSEs Eaaocirence
$250 000
CLAIMS '%''
MADE OCCUR
_ MED EXP (Any one person_)
$5,000
X Staffing $Qrv1Ce3
PERSONAL & ADV INJURY
$ Inal. E&O
GENERAL AGGREGATE $ 2 , 000,000
GEML AGGREGATE LIMIT APPLIES PER:
---
PRODUCTS - COMPIOP AGG $ Included
X POLICY PRO-
JECT LOC
-
AUTOMOBILE LIABILITY
A
ANY AUTO
SSL9518899
10/01/03
10/01/04
COMBINED SINGLE LIMIT
(Ea accitlen[)
$1 000 0 00
r r
ALLOWNEDAUTOS
BODILY INJURY
SCHEDULED AUTOS
(Per person)
$
X HIRED AUTOS
BODILY INJURY
$
X NON -OWNED AUTOS
(Per accident)
PROPERTY DAMAGE
$
----
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
-
$
AUTO ONLY: AGG
EXCESSIUMBRELLA LIABILITY
EACH OCCURRENCE
$ 5 000,000
A
X OCCUR 1:1CLAIMSMADE
BE7123490
10/01/03
10/01/04
AGGREGATE
$5 000 000
DEDUCTIBLE
$
RETENTION $
$
WORKERS COMPENSATION AND
X TORY LIMITS I ER
-__I
B
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE
WC2981214 (*)
10/01/03
10/01/04
E.L. EACH ACCIDENT
$1 000,000
OFFICERIMEMBER EXCLUDED?
E.L. DISEASE - EA EMPLOYEE
$ 1 00O 000
If yes, describe under
E.L. DISEASE - POLICY LIMIT
$ 1 000 000
S
SPECIAL PROVISIONS below
OTHER
A 'Crime/Fidelity
7144444
10/01/03
10/01/04
Crime 1,000,000
A Staffina E60 CvCj.
SSL9518899
10/01/03
10/01/04
E60 Oc 2,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VENICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
*AL,AR,CO,IA,KS,KY,ME,MO,MS,MT,NC,NH,NJ,NM,NV,OK,SC,SD,TX,UT
Location:1016-Ft.Collins,CO; Type of Company: City municipality; Job
Description: Clerical, administrative assistant and general laborer. 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 EXPIRATIO14
DATE THEREOF, THE ISSUING INSURER WALL 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 B. O'Neill
P.O. Box 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Fort Collins, CO 80522-0580 REPRESENTATIVES.
ACORD 25 (2001/08)
0 ACORD
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.
NOTEPAD. INSUREDS NAME Express Services, Inc.
Workers Compensation Policy Schedule Continued:
Policies Effective: 10-1-03 Policies Expiration: 10-1-04
Co.No.: Policy Number: State:
B. WC2981216 CA
B. WC2981218 MN
A.
WC2981215
C.
WC2981217
D.
WC2981219
E.
WC2981220
EXPRE-1 PAGE 3
OP ID KA DATE 09/30/03
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