HomeMy WebLinkAboutSTAFFSCAPES - INSURANCE CERTIFICATE (3)CORD. CERTIFICATE OF LIABILITY INSURANCE O1/181/18/08 M/DDYY)
AA -
PRODUCER
IRA of Colorado, Inc.
0 17th Street
to 600
ver, CO 80202
INSURED
StaffScapee
12000 Pecos St., Suite 300
CO 80234
-I HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
INSURER
INSURERS AFFORDING COVERAGE
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.
INSfl
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MWDD/YYI
POLICY EXPIRATION
DATE flMWDDNY1
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$
FIRE DAMAGE (Any one lire)
$
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE E OCCUR
MED EXP (Any one person)
$
PERSONAL &ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE
POLICY
LIMIT APPLIES PER:
171 PRO LOC
PRODUCTS - COMP/OP AGG
$
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per person)
$
HIRED AUTOS
NON -OWNED AUTOS
BODILYINJURY$
(Per accident) tlent)
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
EA ACC
$
ANY AUTO
$
AUTO ONLY:
AUTO ONLY: AGO
EXCESS LIABILITY
OCCUR CLAIMS MADE
EACH OCCURRENCE
$
AGGREGATE
$
$
DEDUCTIBLE
RETENTION $
$
A
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
4016179
10/01/07
10/01/08
X WC $TATD- OTH-
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$1,000,000
E.L. DISEASE -POLICY LIMIT
$11000,000
OTHER
s
S
S
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
This Certificate shows that A&A Energy Concepts dba H&H Electric 228 S. Link Ln. Fort Collins, CO 80524 is
covered under the Workers Compensation Policy issued to StaffScapee.
City of Fort Collins
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 25-S (7/97) loraeckert
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.