HomeMy WebLinkAboutQWEST - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY)
10/13/2008
PRODUCER
THIS CERTIFICATE IS ISSUED AS A INFORMATION MATTER OF
Marsh USA, Inc.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1301 5th Avenue, Suite 1900
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Seattle, WA 98101
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Attn: Kathy Harid 206 214-3119 Fax: 206 214-3483
100429-QGS-GAW-08 09 kbh cont none
—
INSURERS AFFORDING COVERAGE NAIC #
INSURED
QWEST GOVERNMENT SERVICES, INC.
_ _
INSURER A: National Union Fire Ins Co Pittsburgh PA 19445
1801 CALIFORNIA STREET, SUITE 1150
INSURER B Insurance Company Of The State Of PA 19429
DENVER, CO 80202
--- -- -- —
INSURER C
J
INSURER D:
INSURER E.
COVERAGES -
__- __-_-----___ .._.__ ___-_---.__---14....._
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
LT Ri ADD'L TYPE OF INSURANCE POLICY NUMBER
�LTR
EFFECTIVE POLICY EXPIRATION:
OMITS
,INSRO
ATE
DATE DATE (MMIDD/VY)
A
X
GENERAL LIABILITY
--
X COMMERCIAL GENERAL LIABILITY
GL1871962
10/01/08
10/01/09
EACH OCCURRENCE _
DAMAGE TO RENTED
IF PREMISES Ea occurenpe)
1,00000_
$ 1,000.006I
ll
�� CLAIMS MADE I %�J OCCUR
MED EXP (Any one person)
$ 10,000
PERSONAL It ADV INJURY
$ 1,00,,00,
GENERALAGGREGATE
$ 2,060,000
GENERAL AGGREGATE LIMIT APPLIES PER
......� PRO
PRODUCTS COMP/OPAGG
2,000,000
POLICY JECT LOC
...__
_._.
A
AUTOMOBILE
LIABILITY
CA6077462 (ADS)
10/01/08
10/01/09
COMBINED SINGLE LIMIT
$ 2,000,000,
A
X
ANY AUTO
CA6077463 CT
( )
10/01 /OS
10/01/09
(Ea accident)
A
)(,
ALL OWNED AUTOS
!CA6077464(MA)
10/01/08
10/01/09
BODILY INJURY
—lJ
$
A
SCHEDULED AUTOS
CA6077465(VA)
10/01/08
10/01/09
(Per person)
X
HIREDAUTOS
BODILY INJURY
$
X
NON-OWNEDAUTOS
(Per accident)
X
SELF -INSURED FOR
PROPERTY DAMAGE
$
AUTO PHYSICAL DAMAGE
(Per accident)
GARAGE LIABILITY
(
AUTO ONLY - EA ACCIDENT$
ANY AUTO
OTHER THAN EAACC
$
AUTO ONLY: AGG
$
EXCESSIUMBRELLAUABILITY
EACH OCCURRENCE
$
OCCUR CLAIMS MADEI
AGGREGATE
$
$
DEDUCTIBLE
--
RETENTION $
-
B
WORK
EMPLOYERS. LIABILITY
ADSERSCOMPENSATIONAND WC4800675
( )
�
10/01/08
10/01/09
WC IOTH
XTJ?RY
ElWC4800676(QA)
10/01/08
10/01/09
LIMIT.
,LIMITS Eft
$ 1,000,00�
ANY PROPRIETOR/PARTNERlEXECUTIVE
.L.EACHACCIDENT
---- --
-_---- __—I
B
OFFICEWMEMBER EXCLUDED?
WC4800677(FL)
10/01/08
10/01/09
.L. DISEASE - EA EMPLOYE
$ 1,000,000,
A
If y
8 ECALSPROVISIONS below
WC4800678(OR)
10/01/08
10/01/09
__._..__
.L. DISEASE - POLICY LIMIT
$ 1,000,000
OTHER
B
Workers' Compensation
WC4800679 (TX)
10/01/08
10/01/09
SIR Each Acc/Emp $1,000,000
A
Workers' Compensation
WC4800680 (ND, OH, Wl, WY)
10/01/08
10/01/09
SIR Each Acc/Emp $1,000,000
A
Excess Workers' Compensation IXWC4801276
(WA)
10/01/OS
10/01/09
Excess of SIR $1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
RE: P871 Renewal. Service agreement to provide maintenance of equipment & software for customer -provided equipment at various building locations. The
City of Fort Collins, its officers, agents & employees are Additional Insureds as required by written contract on the General Liability Policy with respect to
referenced service agreement.
CERTIFICATE HOLDER SEA-001092840-05
- - --� __-
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Fort Collins Purchasing
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
215 North Mason, 2nd Floor
P.O. Box 580
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Fort Collins, CO 80522
BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND
UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES,
AOUtTMarsZEpRREE Inc, TATNE ^ ,
Cheryll L. Koch
nwrcu ao tavu Noc) O 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
equire 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.
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