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Home My WebLink AboutEXPRESS SERVICES - INSURANCE CERTIFICATE (6)ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID DATE (MANDp/YYYY) EXPRE-1 09/30/05 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 O 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: Ins CO of the State Of PA INSURER B: Natl• Union Fire Ina Co of PA INSURER C: Bi=icpnan, Fire Ina Co of PA Express Services, Inc. 8516 NW Expresswa,gg Oklahoma City OK 73162 INSURER D: American Home Assurance Co INSURER E: 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. IN*N LTR Avu, NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MWDDIYY POLICY EXPIRATION DATE MWDDIY LIMITS GENERAL LIABILITY EACH OCCURRENCE $5,000,000 PREMISES(Eaoccurence) $250,000 B X COMMERCIAL GENERAL LIABILITY SSL9518899 10/01/05 10/01/06 CLAIMS MADE 1�1 OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ Incl . E&O X Staffing Services GENERAL AGGREGATE $5,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ Included X POLICY jEo- LOC B AUTOMOBILE LIABILITY ANY AUTO SSL9518899 10/01/05 10/01/06 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS X 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 B X OCCUR F—ICLAIMSMADE BE9197155 10/01/05 10/01/06 AGGREGATE $5,000,000 $ DEDUCTIBLE $ RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVESEE OFFICER/MEMBER EXCLUDED? ATTACHED LIST 10/01/05 10/01/06 X I TORY LIMITS 1 1 ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYE $1, 000, 000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1, 000, 000 OTHER B Crime/Fidelity 1909104 10/01/05 10/01/06 Crime 1,000,000 B Staffing R&D Cvg. SSL9518899 10/01/05 10/01/06 E&O Oc/Ag 5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT i SPECIAL PROVISIONS 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. CERTIFICATE HOLDER CANCELLATION CITTrC2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Fort Collins DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Attn : James O'Neil NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Director of Purchasing P.O. Box 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Fort Collins, CO 50524 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001108) ✓ U - 0 ACORD CORPORATION 1988 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. AGORD 25 (2001/05) I Workers- Compensation Policy Schedule: Policies Effective: 10-1-05 Policies Expiration: 10-1-06 Co. No. Policy No. States Covered: A• WC6610555 AK,AL,AR,AZ,CO,CT,DE,FL,GA,IA, ID,IL,IN,KS,KY,LA,MA,MD,ME,MI MN,MO,MS,MT,NC,NH,NJ,NM,NV,NY, OK, PA,SC,SD,TN,TX,UT,VA B. WC6610554 WI (ND,OH,WA,WV,WY Emp.Liab.only) C. WC6610556 OR D• WC6610553 CA ACORD CERTIFICATE OF LIABILITY INSURANCE OPID DATE (MhVDD/YY5 EXPRE-1 09/30/O5 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 O Box 3142 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Tulsa OK 74101 Phone:918-584-1433 Fax:918-582-1319 EFxxp�ress Services, Inc. Im NW Expressway Oklahoma City OK 73162 vWacn, "== INSURERS AFFORDING COVERAGE NAIC # INSURER A: Ins CO of the State Of PA INSURER B: Natl' Union Fire Ins Co of PA INSURER C: Ri.ingham Fire Ins Co of PA INSURERD: American Home Assurance Co INSURER E: 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 INSRE TYPE OF INSURANCE POLICY NUMBER DATE MMIDD/YY DATE (MMIODfYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $5,000,000 B X COMMERCIAL GENERAL LIABILITY SSL9518899 10/01/05 10/01/06 PREMISES'(Eaoaurence> $250,000 CLAIMS MADE [ X] OCCUR MED EXP (Any one Person) $ 5, 000 X Staffing Services PERSONAL &ADV INJURY $ Incl. E&O GENERAL AGGREGATE $5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ Included X JEPOLICY PRO CT LOC AUTOMOBILE LIABILITY H ANY AUTO SSL9518899 10/01/05 10/01/06 COMBINED SINGLE LIMIT (Ea accident) $11000,000 ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS X NON -OWNED AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ $ AUTO ONLY: AGG EXCESS/UMBRELLALIABILITY EACH OCCURRENCE $5,000,000 B X1 OCCUR F-ICLAIMSMADE BE9197155 10/01/05 10/01/06 AGGREGATE $5,000,000 DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND X TORY LIMITS ER EMPLOYERS'LIABILITY A SEE ATTACHED LIST 10/01/05 10/01/06 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1 Q00 000 , , OFFICER/MEMBER EXCLUDED? It yECIAL E.L. DISEASE - EA EMPLOYEE $ 1, 000, 000 PROVISIObe NS SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ 11000,000 OTHER B Crime/Fidelity 1909104 10/01/05 10/01/06 Crime 1,000,000 B Staffing E&O Cvg. SSL9518899 10/01/05 10/01/06 E&O Oc/Ag 51000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Location:1016-Ft.Collins,Co; Type of company: City Municipality; Job Description: Clerical, administrative assistant. 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'Neill P.O. Box 580 Fort Collins, CO 80524 CITYFCI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SMALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ACORD 25 1988 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. Workers' Compensation Policy Schedule: Policies Effective: 10-1-05 Policies Expiration: 10-1-06 Co. No. Policy No. States Covered: A. WC6610555 AK,AL,AR,AZ,CO,CT,DE,FL,GA,IA, ID,IL,IN,KS,KY,LA,MA,MD,ME,MI MN,MO,MS,MT,NC,NH,NJ,NM,NV,NY, OK, PA,SC,SD,TN,TX,UT,VA B. WC6610554 WI (ND,OH,WA,WV,WY Emp.Liab.only) C. WC6610556 OR D. WC6610553 CA