HomeMy WebLinkAboutCUSTOMER SERVICES OF COLORADO - INSURANCE CERTIFICATEDATE (MMIDOIYYYY)
A_CORQ CERTIFICATE OF LIABILITY INSURANCE 03/04/2009
PRODUCER (970)679-7333 FAX (866)4S6-4265 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Ewing -Leavitt Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
4025 St. Cloud Dr. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 100
Loveland, CO 80538 INSURERS AFFORDING COVERAGE NAIC #
--- ----- ---- ---- -----------__
INSURED Custom Services of Colorado, Inc. INsua-RA EMC 21415
796 Abrams Wy INSURERS. Pinnacol Assurance 41190
Loveland, CO 80537-NSURHRC.
INSl112F.R D
INSIIRIiIi I
COVFRAGFS
THE POLICIES OF INSURANCE LISPED BELOW IIAVE BEEN ISSUED "10 THE INSURED NAMED ABOVE FOR 'I'I IF POLICY PERIOD INDICA'FHD NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OIIiER DOCUMI_NT WITH RESPECT TO WIIICII'II1IS CERII FICATE MAYBE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED 13Y I) HE POLICIES DIFSCPIBFD HEREIN IS SUBJECT"ICAL I- II IF 1 ERMS. EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
II TR DDI TYPE OF INSURANCE POLICY NUMBEi2 POLIGVEFPLCFIVE POLIOYMPIRATION LIMITS
_ _UL1IE.(M01(UULYY. 11PJE1M6NUD1YYI__
GENERAL LIABILITY
3X5462508
03/29/2009
03/29/2010
1`ACI I OCCURRENCE
S 1,000,000
X COMMLRCIAI GENERAL LIABILI IY
DAMA(1 IO121 NI D
5 1QQ, QQQ
CLAIMS MADE X OCCUR
f REMISES (Lanccurovco) _
MI I) ( XP (Any o o person)
_ .__
S 5,000
A
P1RPONAI_&ADVINJURY
S 1,000,000
(I NI RAI AOGRI GAu
$ 2,000,000
GFN'I. AGGREGATE LIMI I APPI.IES PER
PRODUCIS - COMI /OP AOG
$ 2,000,000
POLICY XPRO LOC
CT
AUTOMOBILE
LIABILITY
3X5462508
03/29/2009
03/29/2010
COMBINED SINGLE LIMIT
X
ANY AU 10
(Ea acatlenl)
S
1,000,000
BODILY INJURY
$
ALL OWNED AUTOS
SCHEDULED AI/ IOS
(Per person)
A
-
X
HIRED ADIUS
BODILY INJURY
NONOWNEDAU IOS
(Per accdenl)
$
_
X
_.._._
PROPER 'I Y DAMAGE
$
_______.._._...___..._........_...._..._.._.
(PCr eeGtlOnl)
GARAGE LIABILITY
AUTO ONL Y - EA ACCIOE N'I
S
ANY AUTO
03111R THAN I ACC
S
Al1TOOWY AGO
5
EXCESSIUMBRELLrALIAlBILITY
3XS462508
03/29/2009
03/29/2010
I:ACII000U12R1'.NCP
$ 1,000,000
X� OCCUR I_ I CLAIMSMADE
AGGRIGAIT._„
S
A
.._
S
DEDUCTIBLE
S
X RETENTION S 10,00
5
WORKERS COMPENSATION AND
4025555
Dl/Q1/2QQ9
Q1/Q1/201Q
X W( 5IN11 OI'll-
EMPLOYERS' LIABILITY
I IACH ACCIDI NI
$ 1,000 000
B
ANY P120PRIE'I'ORIPARTNEI'LEXICUI'IVE
-
,...__.
OFFICER/MEMBER HXCLUDEDe
L.I. DISEASE. -I A ISMPLOYIEI
S 1, 000, 000
It yes. tleser be untler
SPECIAL PROVISIONS be-lov,
.__. _......
I L ) SI ASl-I 000 JMI1
_..._.. _... _...
i 1, 000, 000
OTER
3X5462508
03/29/2009
03/29/2010
Scheduled Equipment $192,450
A
In�and Marine
$1,000 deductible applies
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
11 Operations / All Locations
City of Fort Collins
James L. Hume, Acting Director
Director of Purchasing & Risk Mgmt.
PO Box 580
Fort Collins, CO 8OS22-0580
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, IHE ISSUING INSURER WILL ENDEAVOR TO MAIL
"3 Q DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
AUTHORIZED REPRESENTATIVE
Christy Herbert
ACORD 26 (2001108) @ACORD CORPORAL "ION 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 forin 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 25 (2001108)