HomeMy WebLinkAboutXEROX CORPORATION - INSURANCE CERTIFICATE (2)CERTIFICATE NUMBER
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
MARSH USA Inc.
NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
601 MERRITT 7
POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
NORWALK, CT 06856
AFFORDED BY THE POLICIES DESCRIBED HEREIN.
CHRISTINE CAYO/ FAX 203-229-6970
XEROX. CERTREQUEST@MARSH. COM
COMPANIES AFFORDING COVERAGE
COMPANY
54000-XEROX-CAS-06-07
A ACE AMERICAN INSURANCE COMPANY
INSURED
COMPANY
XEROX CORPORATION AND ITS SUBSIDIARIES
B INDEMNITY INSURANCE COMPANY OF NORTH AMERICA
800 LONG RIDGE ROAD
STAMFORD, CT 06904
COMPANY
C INSURANCE COMPANY OF NORTH AMERICA
COMPANY
D ACE INSURANCE COMPANY
THIS IS TO CERTIFY THAT 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 MAY BE 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
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE(MMIDDIYY)
POLICY EXPIRATION
DATE(MMIDDIYY)
LIMITS
A
D
C
C
GENERALUABIUTY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
OWNER'S& CONTRACTOR'SPROT
XSL G21713910 (AOS)
41 -PR-020081 0 (PR)
705-00187(GUAM)
705-00188(SAIPAN)
"EXCESS OF A $250,000 EACH"
"OCC. SELF -INSURED
01/01/06
01/01106
01/01/06
01/01/06
01/01/07
01101/07
01/01/07
01/01/07
GENERAL AGGREGATE
$ 10,000,000
PRODUCTS - COMP/OP AGG
$ INCLUDED
PERSONAL& ADV INJURY
$ 1,750,000
EACH OCCURRENCE
$ 1,750,000
FIRE DAMAGE (Any one me)
$ NIA
MED EXP (Any one Icon
$ NIA
A
C
C
D
B
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
ELF INSURED COMP/COLL
ISA H08022112 (AOS)
FAP04710 (GUAM)
FAP04711 (SAIPAN)
28-PRB-200215 (PR)
US 200353-6 (US - VI)
01/01/06
01/01/06
01/01/06
01/01/06
01/01/06
01/01/07
01/01/07
01/01/07
01101/07
01/01/07
COMBINED SINGLE LIMIT
$ 2,000,000
X
BODILY INJURY
(Per person)
$
BODILY INJURY
(Peramident)
$
X
PROPERTY DAMAGE
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN AUTO ONLY:
EACH ACCIDENT
$
AGGREGATE
$
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
EACH OCCURRENCE
$
AGGREGATE
$
$
B
A
A
WORKERS COMPENSATION AND
EMPLOYERS' LABILITY
THE PROPRIETOR/ INCL
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL
WLR C44338300 (AOS)
WLR C44338312 (CA & I D)
SCF C44338324 (WI)
01/01/06
01/01/06
01/01/06
01/01/07
01/01/07
01/01/07
X I TORY LIMITS I I ER
EL EACH ACCIDENT
$ 1,000,000
ELDISEASE-POLICY LIMIT
$ 1,000,000
EL DISEASE -EACH EMPLOYEE
$ 1 ,000,000
C
C
A
OTHER
WORKERS COMPENSATION
CONTINUED
EXCESS WC OHIO ONLY
601 N 00366 (SAIPAN)
601 N 00367 (GUAM)
XWC C44338294 (OH ONLY)
01101/06
01/01/06
01/01/06
01/01/07
01/01/07
01/01/07
SEE ABOVE WORKERS COMP LIMITS
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 HEREN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,
THE INSURER AFFORDING COVERAGE WALL ENDEAVOR TO MAIL _gyp DAYS WRITTEN NOTICE TO THE
CERTIFICATE HOLDER NAMED HEREN, 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.
NARSH USA INC.
BY: Thomas J. Edridge 171p"vrAo'4'
MM9I3/021 VALJD AS OF:.12/21/OS