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HomeMy WebLinkAboutEXPRESS SERVICES - INSURANCE CERTIFICATE (5)ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID DATE(MM/DD/YYYY) EXPRE-1 07 28 05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Arthur J. Gallagher RMS, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P 0 Box 3142 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Tulsa OK 74101 Phone:918-584-1433 Fax:918-582-1319 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: National Union Fire Ina Co of INSURER B. American Home Assurance Co I INSURER C. Illinois National Ins CO Ex p rea9 Services, Inc. 8516 NW Expressway Oklahoma City OK 73162 INSURER D: amarican International South INSURER E. In3 CO Of the State Of PA 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. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATEYMM/DOM' PDATE MM/ODm LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000 O00 A X COMMERCIAL GENERAL LIABILITY SSL9518899 10/01/04 10/01/05 PREMISES(Eaoccurence) $250000 CLAIMS MADE •• , OCCUR MED EXP (Any one person) $ 5,000 PERSONAL B ADV INJURY $Intl. E&O X Staffing Services GENERAL AGGREGATE $2,0D0,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGO $Included X POLICY PRO- JECT LOC A AUTOMOBILE LIABILITY ANY AUTO SSL9518899 10/01/04 10/01/05 COMBINED SINGLE LIMIT (Ea accident) $1 OOO,OOO BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X BODILY INJURY (Per accident) $ HIRED AUTOS -OWNED AUTOS xiNON PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY. AGO $ ANY AUTO 1 $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $5,000 000 A X iOCCUR �CLAIMSMADE BE3479580 I 10/01/04 10/01/05 AGGREGATE s5,000,000 $ i $ DEDUCTIBLE $ RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANVPROPRIETOR/PAR?NER/EXECUTIVE OFFICER/MEMBER EXCLUDED? WC5898755 (*� 10/01/04 10/01/05 X I TORY LIMITS ER E.L.EACH ACCIDENT $1,00D,DDD _ E.L. DISEASE- EA EMPLOYEE$1,00D,000 If yes, describe under SPECIAL PROVISIONS below E. L. DISEASE -POLICY LIMIT $1 DDD DDO OTHER A Crime/Fidelity 0663512 10/01/04 10/01/05 Crime 1,000,000 A Staffing E&O Cv . SSL9518899 10/01/04 10/01/05 E&O Oc/Ag 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / 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, help setup stage props. All insurance carriers shown on this certificate have an A.M. Best Rating of A++XV unless otherwise noted. City of Fort Collins Attn: James O'Neil Director of Purchasing P.O. Box 580 Fort Collins, CO 50524 CITYFC2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO1 DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 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 REPRESENTATIVES. ACORD 25 (2001108) ©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. _ rm' 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: B. WC5898759 B. WC5898758 A. WC5898761 C. WC5898757 D. WC5898760 E. WC5898756 F. WC5898808 B. WC5898843 State: CA MN WI and Monopolistic Emp. Liab. CT, FL, IL, IN, LA, MI, NY, PA GA AZ, ID, MA, MD, TN, VA OR NV