HomeMy WebLinkAboutOPTIO SOFTWARE - INSURANCE CERTIFICATE (2)ACORD- CERTIFICATE OF LIABILITY INSURANCE 0DATE 4/03/4/03/MIDDIYYYY)
06
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Wachovia Insurance Serv-AT, GA ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
4401 Northside P Suite 400 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Atlanta, GA 30327-3078
770 850-0050 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURERA: Hartford Fire Insurance Company 19682
Optio Software, Inc. INSURER B: Hartford Casualty Insurance Company 29424
3015 Windward Parkway
INSURER C:
Windward Fairways 11
INSURER D:
Alpharetta, GA 30005
INSURER E:
nnvPRAnPA
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
NSR
TYPE OFINSURANCE
POLICY NUMBER
DATE(MMIDDIYYPOLICY E
POLICY
DATE MMPIRATION
LIMITS
A
GENERAL LIABILITY
2000NUX4610
04/03/06
04/03/07
EACH OCCURRENCE
$1 00O 000
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTEDPREMISE (Ea cm
$300 0OO
CLAIMS MADE a OCCUR
MED EXP (Any one person)
$10 000
PERSONAL B ADV INJURY
$1 000 000
GENERAL AGGREGATE
$1 00O 000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$1 000 000
POLICY PER0-
T LOC
A
AUTOMOBILE
LIABILITY
ANY AUTO
2000NUX4610
04/03/06
04/03/07
COMBINED SINGLE LIMIT
(Ea accident)
$1 000 000
, ,
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULEDAUTOS
X
BODILY INJURY
(Per accident)
$
HIREDAUTOS
NON -OWNED AUTOS
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
B
EXCESSIUMBRELLA LIABILITY
20RHUUX5493
04/03/06
04/03/07
EACH OCCURRENCE
$10 000 000
X OCCUR CLAIMS MADE
AGGREGATE
$10 00O 000
$
DEDUCTIBLE
1XI
$
RETENTION $ 10 000
B
WORKERS COMPENSATION AND
20WB606841
04/03/06
04/03/07
OTH-
X TTORUsLamNuiI ER
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNEWEXECUTIVE
E.L. EACH ACCIDENT
$500 000
E.L. DISEASE - EA EMPLOYEE
$500OOO
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
1500,000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Where required by written agreement, the Certificate Holder is included as an Additional
Insured under the General Liability insurance, but only for work performed by or
on behalf of the Named Insured.
City of Ft. Collins
Attn: James B. O'neill
215 North Mason Street
2nd Floor, P.O. Box 580
Fort Collins, CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL A0_ 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 REPRESENT TIV
For WIS by: /d
A(:UKU L* (LUU7/UN) 1 of 2 #S1000721/M1000716 DLS01 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.
ACORD 25S (2001/08) 2 of 2 #S1000721/M1000716