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Home My WebLink AboutEXPRESS SERVICES - INSURANCE CERTIFICATE (3)ACORD,M CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 5 7 2009 PRODUCER Phone: 800-888-3910 Fax: 312-527-9473 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Hilb Rogal & Hobbs (HRH) ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE One East Wacker Drive, Suite 1800 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Chicago IL 60601 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE I NAIC # INSURED 4 INSURERA:National Union Fire Insurance Express Services, Inc. INSURER B: Insurance Com1pany of the Stat 8516 NW Expressway Oklahoma City OK 73162 INSURERC:Illinois National Insurance C INSURER D: INSURER E: rnVFRAnFS 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. INSRADD` LTR L POLICYNUMBER POLICY EFFECTIVE DD POLICY EXPIRATION M D LIMITS A X GENERAL LIABILITY SSL9518899 10/l/2008. 10/1/2009 EACH OCCURRENCE $ 5 00O 000 MERCIAL GENERAL LIABILITY DAMAG TO RENTED PREMISES Ea occurence $ 2 5 0 0 0 0 MED EXP (Anyone person) $ 5 000 CLAIMSMADE � OCCUR LtXqcoM PERSONAL & ADV INJURY $ Included affi ng SPrvi c-P GENERAL AGGREGATE $ 5 000 000 GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS -COMP/OPAGG $ Included X I POLICY PRO-jECT LOC A X AUTOMOBILE LIABILITY ANY AUTO SSL9518899 10/l/2008 10/1/2009 COMBINED SINGLE LIMIT (Ea accident) $ 1, 000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ X X HIREDAUTOS NON-OWNEDAUTOS PROPERTYDAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY -EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG A X EXCESS/UMBRELLA LIABILITY X OCCUR D CLAIMS MADE 5474999 10/1/2008 10/1/2.009 EACHOCCURRENCE $ 10 000 000 AGGREGATE $ 10 000 000 $ DEDUCTIBLE $ RETENTION $ B C. WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE 4800771 SEE ATTACHED LIST 10/1/2008 10/l/2008 10/1/2009 10/1/2009 X I ORY LIMITSOER E.L. EACH ACCIDENT $ 1 000 000 E.L. DISEASE - EA EMPLOYEE $ 1 000 000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1 0 0 0 000 A OTHER Crime/Fidelity Staffing E&O Coverage 1757787 SSL9518899 10/1/2008 10/1/2008 10/1/2009 10/1/2009 IE&O Crime/Fidelity 1, Y S 000,000 Occ/Agg $5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS 11 insurance carriers shown on this certificate have an A.M. Best Rating A XV unless otherwise noted. Location: 1016 - Ft. Collins, CO Type of Company: City Municipality Job Description: Clerical and administrative support wr+ rvw�r� %1M11VC1-LA I IVIY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER City of Fort Collins WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE Attn: James O'Neill CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO 215 North Mason Street SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON Fort Collins CO 80521 THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) TION 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. ACORD Z5 (ZQ01/OS) Workers' Compensation Policy Schedule: Policies Effective: 10/1/08 Policies Expiration 10/1/09 B. Insurance Company of the State of PA Policy No. 4800771 NAIC # 19429 States Covered: AK,AR,CO,DE,GA,HI,ID,ME,MS,MT,NC,NH,NM,NV,OK,PA,RI,SD,TN,UT,VA,VT,WV B. Insurance Company of the State of PA Policy No. 4800772 NAIC # 19429 States Covered: CA B. Insurance Company of the State of PA Policy No. 4800829 NAIC # 19429 States Covered: NY A. National Union Fire Insurance Company Policy No. 4800777 NAIC# 19445 States Covered: ND,WA,WI,WY C. Illinois National Insurance Company Policy No. 4800770 NAIC# 23817 States Covered: AL,AZ,CT,IA,IL,IN,KS,KY,LA,MA,MD,MI,MN,MO,NE,NJ,SC C. Illinois National Insurance Company Policy No. 4800774 NAIC# 23817 States Covered: FL D. AIG Casualty Company Policy No. 4800775 NAIC# 19402 States Covered: OR E. New Hampshire Insurance Company Policy No. 4800773 NAIC# 23841 States Covered: TX A. National Union Fire Insurance Company Policy No. WCXS4801318 NAIC# 19445 States Covered: OH REV 01-01-09