HomeMy WebLinkAboutUNTILX - INSURANCE CERTIFICATEACORDN CERTIFICATE OF LIABILITY INSURANCE page 1 of 2
12/16/2005
PRODUCER 877-945-7378
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Willis North America, Inc. - Regional Cart Center
26 Century Blvd.
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. O. Box 305191
Nashville, TN 372305191
INSURERS AFFORDING COVERAGE
NAIC#
INSURED Uti1X Corporation
INSURERA: Arch Insurance Company
11150-001
INSURER B:
22820 Russell Road
P.O. Box 97009
INSURO C:
Rent, SPA 98064
NSURER 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
DD'
TYPE OFINSURANCE
POLICY NUMBER
POLICYEFFECTIVE
POLICY EXPIRATION
LIMITS
_Lmnm
A
GENERAL LIABILITY
71PXG2066202
1/1/2006
1/1/2007
EACHOCCURRENCE
$ 11000,000
X COMMERCIAL GENERAL LIABILITY
PREMISES RENTED
$ 100.000
CLAIMS MADE I-X I OCCUR
MED EXP(Anyone person)
$ 10,000
PERSONAL&ADV INJURY
$ 1,000,000
GENERALAGGREGATE
$ 51000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMP/OP AGG
$ 2,000,000
POLICY X PRO LOC
A
AUTOMOBILE
LIABILITY
ANY AUTO
71PXG2066202ALLSTATE
1/l/2006
1/1/2007
COMBINED SINGLE LIMIT
(Ea accident)
$ 11000,000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
BODILY INJURY
(Peraccident)
$
HIREDAUTOS
NON -OWNED AUTOS
X
PROPERTYDAMAGE
(Peraccident)
$
GARAGEUABILITY
AUTO ONLY -EA ACCIDENT
$
OTHERTHAN EAACC
$
ANY AUTO
$
AUTOONLY: AGG
EXCESS LIABILITY
EACHOCCURRENCE
$
OCCUR CLAIMS MADE
AGGREGATE
$
$
DEDUCTIBLE
$
RETENTION $
A
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
71WCI2066102
1/l/2006
1/l/2007
TH
X wcYTLISa iu- EEL
E.L. EACH ACCIDENT
$ 11000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. DISEASE - EA EMPLOYEE
$ 11000,000
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
$ 11000,000
OTHER
DESCRIPTION OF OPERATIONS/LGCATONSJVEHICLEZiXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Re: Any and all locations
General Liability Coverage: STOP GAP INCLUDED
City of Fort Collins is an additional insured as respects their interest in the operations of the
named insured as required by written contract regarding general liability.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
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 SMALL
City of Fort Collins
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
James B. O'Neill, 11 CPPO
REPRESENTATIVES.
AU E ESENTA
256 N. Mountain Ave.
Fort Collins, CO 80522-0580
ACORD 25 (2001/08) Coll:1489068 Tpl:443375 Cert:6606198 ®ACORDCORPORATION 1988
Page 2 of 2
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.
Coll:1489068 Tpl:443266 Cert:6606910