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Home My WebLink AboutXEROX CORPORATION - INSURANCE CERTIFICATECERTIFICATE NUMBER NYC-000605802-04 II PRODUCER MARSH USA Inc. 601 MERRITT 7 NORWALK, CT 06856 CHRISTINE KIMBELL/ FAX 203-229-6970 XEROX.CERTREOUEST@ MARSH.COM J 54000-X E ROX -CAS-04-05 INSURED XEROX CORPORATION AND ITS SUBSIDIARIES 800 LONG RIDGE ROAD STAMFORD, CT 06904 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES DESCRIBED HEREIN. COMPANIES AFFORDING COVERAGE COMPANY A ACE AMERICAN INSURANCE COMPANY COMPANY B COMPANY C COMPANY D THIS IS TO CERTIFYTHAT 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 MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTA TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A A A X GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMSMADE ❑X OCCUR OWNER'S 8 CONTRACTOR'S PROT XSLG21690557(US) CGL 322548(CANADA) 41-PR-0200325 (PR) GENERAL LIABILITY POLICY APPLIES EXCESS OF A $250,000 EACH OCC. SELF -INSURED RETENTION. 01/01/04 01/01/04 01/01/04 01/01/05 01/01/05 01/01/05 GENERAL AGGREGRATE S 10.000,000 PRODUCTS-COMP/OP AGG INPLUDED ABOVE ::: PERSONAL BAOV INJURY $ 1,750,000 EACH OCCURRENCE $ 1,750,000 FIRE DAMAGE (Any one fire) $ N/A MED EXP (Any one person) $ N/A A A A A X X AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNEDAUTOS SELF INSURED COMP/COLL ISA HO 795997-7(AOS) CAC424333 (CANADA) 28-PRB200215(PH) 28-USB-3658(US VI) 01/01/04 01/01/04 01/01/04 01/01/04 01/01/05 01/07/05 01/01/05 01/01/05 COMBINED SINGLE LIMIT $ 2,000,000 BODILY INJURY (Per person) $ BODILY INJURY (per (per accident) PROPERTY DAMAGE $ GARAGE LIABILITY ANY ALTO ALTO ONLY- EA ACCIDENT S OTHER THAN ALTO ONLY. EACHACCIDENT $ AGGREGATE $ EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE AGGREGATE $ $ A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY THE PROPRIETOR/ PARTNERS/EXECUTIVE INCL OFFICERS ARE: EXCL WLRC4353657-6(AOS) SCFC4353728-3 (WI) 01/01/04 01/01/04 01/01/05 01/01/05 X WCSTATU- TORY LIMITS OTH- ER EL EACH ACCIDENT $ 1,000,000 EL DISEASE -POLICY LIMIT $ 1,000,000 EL DISEASE -EACH EMPLOYEE $ 1.000.000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS CITY OF FORT COLLINS ATTN: JAMES B. O'NEILL 256 W. MOUNTAIN AVENUE P.O. BOX 580 FORT COLLINS, CO 80522-0580 SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE, ITS AGENTS OR REPRESENTATIVES, OR THE ISSUER OF THIS CERTIFICATE. MARSH USA INC BY: Connie Chi