HomeMy WebLinkAboutUNITED SITE SERVICES - INSURANCE CERTIFICATE (2)ACORD,, CERTIFICATE OF LIABILITY INSURANCE DATE 1 /ODIVYYY)
10/31/OB
PRODUCER 1-212-295-8000 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Integro USA Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
dba Integro Insurance Brokers HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1 State Street Plaza ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
9th Floor
New York, NY 10004
INSURERS AFFORDING COVERAGE NAIC#
INSURED
UNITED SITE SERVICES INSURFRA Liberty Nut Fire Ins Co 23035
INSURERD:American Guarantee & Liability n Is 26247
P.O. BOX 219 ..
INSUREnC Liberty Ins Corp 42404
CITY, CO 80037
UUVt;hAUtZ>
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 ADD' ..... r_. _... — ___—. __ - __ __ __..
PDATEI
LTR R POLICY NUMBER DATEI WDO,YIVE
DATE MOD V DATE MM LIMITS
MIDDIYI
A
GENERAL LIABILITY
TB2-641-435338-028
11/03/08
11/03/09
EACHOCCURRENCE
$1,000,000
X COMMERCIALGENERAL LIABILITY
DAMAGE TO RLNTED -- _
PREMISES (Fa accurence),
-- "'- —
S 100, 000
__
_X
CLAIMS MADE IOCCUN
MEDEXP(Anyoneperson)
$10,000
PERSONAL&ADV INJURY
S 1, 000,000
GENERALAGGREGATE
$2,000,000
GENT. AGGREGATE LIMIT APPLIES PER:
_.
PRODUCES COMP/OPAGG
$2,000,000
PNO-
X POLICY F- T LOC
.._._.___-
I
—�
A
AUTOMOBILE
LIABILITY
AS2-641-435338-038
11/03/08
11/03/09
COMBINED SINGLE LIMIT
S2,000,000
X
ANY AUT O
(Ea accident)
X
ALLOWNEDAUTOS
---��
—
BODILY INJURY
S
SCHEDULED AUTOS
(Per person)
HIREDAUTOS
—_
--
Ber
S
NONOWNED AUTOS
accident)
(Per accitlen0
PROPERTVDAMAGE
S
(Peraccitlen0
_GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
S
ANYAUTO
OEA ACC
HA
$
AUTOUTO ONLY: ONLY: AEG
$
B
EXCESS/UMBRELLA LIABILITY
ADO 427541604
11/03/08
11/03/09
EACHOCCURRENCE
S5, 000, 000
X__ OCCUR I _ICLAIMSMADE
AGGREGATE
$ 5,000, 000
DEDUCTIBLE
$
RETENTION S
S
C
WORKERS COMPENSATION AND
WA7-64D-435338-018
11/03/08
11/03/09
X WCSTATU- JOIN
EMPLOYERS'LIABILITY
TORYLIMIT$
ANY PROPRIETOWPgRTNER/EXECUTIVE
.
EL EACH ACCIDENT
_ ...._.
$1, 000,000
OFFICER/MEMBER EXCLUDED?
ELDISEASE EA EMPLOYEE
$1, 000, 000
It yes. describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
$1, 000, 000
OTHER
DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDOflSEMENT/ SPECIAL PROVISIONS
CITY OF FORT COLLINS IS AN ADDITIONAL INSURED AS REQUIRED BY WRITTEN CONTRACT.
CITY OF FORT COLLINS
PO BOX 580
COLLINS, CO 80522
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
USA
25(2001/08)Carmen. LloydOintegrogroup. com_ NY
IRT:T7
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.