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ACORDDATE
. CERTIFICATE OF LIABILITY INSURANCE Page 1 of 2 01/05/2005
PRODUCER 877-945-7378 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Willis North America, Inc. - Regional Cart Center HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
26 Century Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. 0. Box 305191
Nashville, IN 372305191 INSURERS AFFORDING COVERAGE NAIL#
INSURED Uti1X Corporation INSURERA: Arch Insurance Company 11150-001
22820 Russell Road
P.O. Box 97009 INSURERS:
Kent, WA 98064 INSURERC:
COVERAGES
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
D
TYPE OF INSURANCE
POLICY NUMBER
POLICYEFFECTIVE
POLICY EXPIRATION
LIMITS
A
GENERAL LIABILITY
71PKG2001901
1/l/2005
l/1/2006
EACHOCCURRENCE
$ 1,000,000
X COMMERCIAL GENERAL LIABILITY
CLAIMSMADE ® OCCUR
DAMAGE TO REN
PRE MI ESE oc ureTEDnce
$ 100,000
MED EXP(Any one person)
$ 10,000
PERSONAL B ADV INJURY
$ 11000,000
GENERALAGGREGATE
$ 5,000,000
GENL AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMP/OP AGG
$ 2,000,000
POLICY X PRO LOC
A
AUTOMOBILE
LIABILITY
ANY AUTO
71PKG2001901ALLSTATE
1/l/2005
l/l/2006
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
BODILY INJURY
(Perexident)
$
HIREDAUTOS
NON•OWNEDAUTOS
X
PROPERTYDAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY -EA ACCIDENT
$
OTHERTHAN EAACC
$
ANY AUTO
$
AUTOONLY: AGG
EXCESS LIABILITY
OCCUR CLAIMS MADE
EACHOCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
$
RETENTION $
A
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
71WCI2001801
1/1/2005
1/1/2006
X I TSAYlAiiTufs OTH-
E.L. EACH ACCIDENT
$ 11000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED?
If yes, describe under
E.L. DISEASE - EA EMPLOYEE
$ 11000,000
E.L. DISEASE -POLICY LIMIT
$ 1,000,000
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Re: Any and all locations
Workers Compensation Coverage:
STOP GAP INCLUDED
City of Fort Collins is an additional insured as respects their interest in the operations of the
Inamed insured as reguiredwritten contract reCFarding generalliability,
City of Fort Collins
James B. O'Neill, 11 CPPO
256 W. Mountain Ave.
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 3 O 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
D25(2001/08) C011:11806
:336291 Cert:5312920
1988
Page 2 of 2
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 (2001/08) Co11:1180612 Tp1:336291 Cert:5312920