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HomeMy WebLinkAbout458840 C & S SPECIALTY SYSTEMS INC - INSURANCE CERTIFICATE (3)ACORP, CERTIFICATE OF LIABILITY INSURANCE M/2 YVY) PRODUCER (303)674-5501 FAX (303)674-3571 Colorado BW Insurance Agency, Inc. PO Box 3849 Evergreen, CO 80437 0210 9/2 2/0009 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURED C&S Specialty Systems, LLC S609 W 6th Ave., Unit B Lakewood, CO 80214 INSURERS AFFORDING COVERAGE INSURERA: Scottsdale Ins Co NAIC # INSURERS. State Auto Insurance 25127 INSURERC Pinnacol Assurance 41190 INSURER D: INSURER E: nnvconncn 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. Y NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS NSR DD' TYPE OF INSU7PER A GENERALLIABILITYCLS1458011 X COMMERCIAL GE CLAIMS MAD 02/Q8/2009 02/08/2010 EACHOCCURRENCE $ 1,000,000 DAMAGE TO RENTED $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 21000,000 GENT AGGREGATE LIM X POLICY JEO1,000,000 PRODUCTS - COMP/OP AGO $ AUTOMOBILELIABILITBAP222069300 ANY AUTO(Eaaccidonp ALLOWNED AUTOSCHEDULED 07/01/2008 07/01/2009COMBINED SINGLE LIMIT $1,000,OQO X INJURY (Per person) $ B AUTOBODILY HIRED AUTOS NON -OWNED AUTOBODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY � EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY X OCCUR CLAIMS MADE. UMS0022170 62/08/2009 02/08/2010 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 DEDUCTIBLE X RETENTION $ 10,00 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 4109630 02/01/2009 02/01/2010 X WC STATU- OTH- C ANY PROPRIETORIPARTNERIEXECUHVE OFFICER/MEMBER EXCLUDED? E.L. EACH ACCIDENT g j�QQQQQQ E.L. DISEASE - EA EMPLOYEE $ j QQQ�QQQ 1! yes, describe under SPECIA!_PROV,SIONC heb�c OTHER EXI' NOD .920 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS City of Fort Collins 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 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR RGFBESEnrcnnvee AUTHORIZED REPRESENTATIVE Carol Reinoehl ©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.