No preview available
HomeMy WebLinkAboutCORRESPONDENCE - GENERAL CORRESPONDENCE - INSURANCE (3)AR LIABILITY INSURANCE DATEYY) CERTIFICATE OF 12/22/05 /05 PRODUCER 1-303-534-4567 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The INA Financial Group, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE INA of Colorado, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1550 17th Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 600 Denver, CO 80202 INSURERS AFFORDING COVERAGE INSURED Employer Services Group LLC INSURER A:Pinnacol Assurance INSURER B: 7000 E. Selleview Avenue Suite 290 INSURERC: Greenwood Village, CO 80111 INSURER D: 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. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDONY) POLICY EXPIRATION DATE IMMIDD/M LIMITS GENERAL LIABILITY EACH OCCURRENCE $ FIRE DAMAGE (Any one (ire) $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE ❑ OCCUR MED EXP (Any one person $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PRO- LOC JrCT AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per Perms) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ $ DEDUCTIBLE $ RETENTION $ A WORKERS COMPENSATION AND 4027173 03/01/05 03/01/06 X WCSTATU- OTH- EMPLOYERS' LIABILITY E.L. EACH ACCIDENT S1,000,000 E.L. DISEASE- EA EMPLOYE $ 1, 000, 000 E.L. DISEASE -POLICY LIMIT 1 $1, 000, 000 OTHER S S S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS This Certificate shows that Rocky Mountain Pavement Maintenance, 2001 W. 64th Lane, Denver, CO 80221 is covered under the Workers Compensation Policy issued to Employer Services Group LLC. 2006JAN 3 PM12:16 CERTIFICATE HOLDER I I ADDITIONAL INSURED: INSURER LETTER: CANCELLATION 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 PURCHASING DEPARTMENT NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL PO BOX 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE FORT COLLINS, CO 80522 USA ACORD 25-S (7/97) ESGCERTS Q ACORD CORPORATION 1988 3765403 Powered ByCertificalesNowly 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. AWRD 25-5 (7l87)