HomeMy WebLinkAboutEMPLOYER SERVICES GROUP - INSURANCE CERTIFICATE (3)ACORN, CERTIFICATE OF LIABILITY INSURANCE
DATE(MMDDVY)
12/22/OS
PRODUCER 1-303-534-4567
The INA Financial Group, Inc.
IRA of Colorado, Inc.
1550 17th Street
Suite 600
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
Denver, CO 80202
INSURED
Employer Services Group LLC
INSURER A: Pinnacol Assurance
INSURER B:
7000 E. Belleview Avenue
INSURER C:
Suite 290
INSURERD:
Greenwood Village, CO 80111
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.
ILTR NSR
TYPE OF INSURANCE
POLICY
POLICY EFFECTIVE
POLICY EXPIRATION
NUMBER
DATE (MMIDDIYYW
DATE IMLVDDrIYI
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$
FIRE DAMAGE (Any one fire)
_
$
COMMERCIAL GENERAL LIABILITY
MED EXP (Any one person)
$
CLAIMS MADE 1:1OCCUR
PERSONAL a ADV INJURY
$
GENERAL AGGREGATE
$
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$
POLICY PRO- LOC
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
$
ANY AUTO
(Ea accident)
ALL OWNED AUTOS
BODILY INJURY
$
SCHEDULED AUTOS
(Per person)
HIRED AUTOS
BODILYINJURY
$
NON -OWNED AUTOS
(Perraccident)
accitlenl)
PROPERTY DAMAGE
$
(Per accident)
GARAGE
LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESS LIABILITY
EACH OCCURRENCE
$
AGGREGATE
_
.$
OCCUR CLAIMS MADE
I$
DEDUCTIBLE
$
RETENTION $
A
WORKERS COMPENSATION AND
14027173
03/01/05
03/01/06
X WCSTATU- OTH-
EEL
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1, 000, 000
E.L. DISEASEPOILIMIT
$1,000400
OTHER
--7
S
S
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
This Certificate shows that Rocky Mountain Pavement Maintenance, 2001 N. 64th Lane, Denver, CO 80221 is covered under
the Workers Compensation Policy issued to Employer Services Group LLC.
CITY OF FORT COLLINS
PURCHASING DEPARTMENT
PO BOX 580
FORT COLLINS, CO 80522
USA
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 SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
AUTHORIZED REPRESENTATIVE
ACORD 25S (7/97) ESGCERTS
3765403
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