HomeMy WebLinkAboutSUPERIOR SPECIAL SERVICES - INSURANCE CERTIFICATE.•ORa
gMA fi,t, CERTIFICATE NUMBER"
fi HOU-000294552-00
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
WELLS FARGO PLAZA
POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
1000 LOUISIANA
AFFORDED BY THE POLICIES DESCRIBED HEREIN.
SUITE 4000
HOUSTON, TX 77002
COMPANIES AFFORDING COVERAGE
COMPANY
J�Jt
0056 -SSI-COPS-02/03 SCHC
ACOMMERCE & INDUSTRY INSURANCE
INSURED
COMPANY
SUPERIOR SPECIAL SERVICES, INC.
B AMERICAN HOME ASSURANCE CO
5098 PARIS STREET
COMPANY
DENVER, CO 80239
C AMERICAN INTERNATIONAL SPECIALTY LINES INS CO
COMPANY
D INS. CO. OF THE STATE OF PA
4 — _
1 •e. e _9 ye
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. LIMITS SHOWN
MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MMIDDIYY)
POLICY EXPIRATION
DATE (MM/DDIYY)
LIMITS
A
GENERAL
LIABILITY
GL 417 7311
07/01/02
07/01/03
GENERAL AGGREGATE
$ 1,000,000
X
PRODUCTS - COMP/OP AGG
$ 1,000,000
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
- _ -
•
PERSONAL 8 ADV INJURY
$ 1,000.000
EACH OCCURRENCE
$ 1,000,000
OWNER'S & CONTRACTOR'S PROT
X
FIRE DAMAGE (Any one fire)
$ 1,000,000
nowgArTi jAi I iAgn iTY
MED EXP (Any oneperson)
$ 5,000
H
AUTOMOBILE
LIABILITY
D004A00055 (TX)
07/01/02
07/01/03
COMBINED SINGLE LIMIT
$ 1,000,000
X
G
ANY AUTO
D004A00056(MA)
07/01/02
07/01/03
BODILY INJURY
(Per Person)
$
G
G
ALL OWNED AUTOS
SCHEDULEDAUTOS
D004A00057(PR)
D004A00058(AOS)
07/01/02
07/01/02
07/01/03
07/01/03
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
$
rl
GARAGE LABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
OTHER THAN AUTO ONLY
EACH ACCIDENT
$
AGGREGATE
$
E
EXCESS LIABILITY
7020222
07/01/02
07/01/03
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 5,000,000
E
X UMBRELLA FORM
853-5379
07/01/02
07/01/03
$
OTHER THAN UMBRELLA FORM
D
WORKERS COMPENSATION AND
EMPLOYERS'LIABILITY
WC 4552998 (AOS)
07/01/02
07/01/03
X A LI
TORV LIMITS ER
�- -= a
....,,,�$ .<,t- :.a"-"
A
WC 4553001(ND,OH,WA,WI,WV,W
/01/02
07/01/03
EL EACH ACCIDENT
$ 1,000,000
B
F
THE PROPRIETOR/ X INCL
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL
WC 4553000 (CA)
WC 4552999 AZlID/MDNA
( )
07/01/02
07/01/02
07/01/03
07/01/03
EL DISEASE -POLICY LIMIT
$ 1,000,000
EL DISEASE -EACH EMPLOYEE
$ 1,000,D00
C
CONTRACTORS
COPS 6192159
09/30/01
09/30/04
EACH CLAIM �,
OPS & PROF SVCS ENV INS
TOTAL ALL CLAIMS 15,000,000
CLAIMS MADE FORM
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS (LIMITS MAY BE SUBJECT TO DEDUCTIBLES OR RETENTIONS)
CITY OF FORT COLLINS IS INCLUDED AS ADDITIONAL INSURED(EXCEPT AS RESPECTS ALL COVERAGE AFFORDED BY THE WORKER'S
COMPENSATION POLICY) AS REQUIRED BY WRITTEN CONTRACT, BUT ONLY FOR LIABILITY ARISING OUT OF THE OPERATIONS OF THE NAMED
INSURED.
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SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,
THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL _'A DAYS WRITTEN NOTICE TO THE
CITY OF FORT COLLINS
256 W. MOUNTAIN AVENUE
CERTIFICATE HOLDER NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
ATTN :JOH N STEPHEN
LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE, ITS AGENTS OR REPRESENTATIVES.
FORT COLLINS, CO 80522
MARSH USA INC.
BY: Barry N. Smith
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