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HomeMy WebLinkAboutUNITED SITE SERVICES - INSURANCE CERTIFICATE (3)ACO' `�,. CERTIFICATE ®F LIABILITY INSURANCE DATE 10/26 //09IYYYY) 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 INSURERA:Liberty Mut Fire Ins Co 23035 UNITED SITE SERVICES INSURER B: American Guarantee 6 Liability ins 26247 P.O. BOX 219 INSURER C: Liberty Ins Corp 42404 COMMERCE CITY, CO 80037 INSURERD: CAVFRA[:FA 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 LTR ADD'L NSR POLICY NUMBER POLICYEFFECTIVE DATE (MMIDDrM POLICY EXPIRATION DATE MM DD LIMITS A GENERAL LIABILITY TB2-641-435338-029 11/03/09 11/03/10 EACH OCCURRENCE $1,000,000 DAMAGETOREN PREMISES Eaoccurence $ 300,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE Fx_] OCCUR MED EXP (Any one person) $10,000 PERSONAL BADVINJURY $ 1,000,000 GENERALAGGREGATE $2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000,000 X POLICY PRO- LOC A AUTOMOBILE X LIABILITY ANYAUTO AS2-641-435338-039 11/03/09 11/03/10 COMBINED SINGLE LIMIT (Ea accident) $2,000,000 BODILYINJURY (Per person) $ X ALLOWNEDAUTOS 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 B EXCESS/UMBRELLALIABILITY AUC-4275416-05 11/03/09 11/03/10 EACH OCCURRENCE $25,000,000 X OCCUR 171 CLAIMSMADE AGGREGATE $25,000,000 $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WA7-64D-435338-019 11/03/09 11/03/10 X WCSTATU- OH- TORY LIMITER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 OFFICER/MEMBEREXCLUDED? If yyes, describe under SP- IALPROVISIONSbelow E.L. DISEASE -POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CITY OF FORT COLLINS IS AN ADDITIONAL INSURED AS REQUIRED BY WRITTEN CONTRACT. V CK I It R.A 1 C r1ULUGK UANUCLL.A I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITY OF FORT COLLINS 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 PO BOX 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. FORT COLLINS, CO 80522 AUTHORIZEDREPRESENTATIVE USA , ACORD 25 (2001/08) Carmen. Lloyd@integrogroup. com NY ©ACORD CORPORATION 1988 13421511 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 25 (2001/08) 3:4