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Home My WebLink AboutQWEST GOVERNMENTAL - INSURANCE CERTIFICATETHE 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. NSP LTR ADD' INSR TYPE OF INSURANCE POLICY NUMBER P0UCYEFFECTNE DATE(MWDDA'YYY) POLICY EXPIRATXXY DATE(MINDDIYYYY) LIMITS A X. GENERAL LIABILITY X I COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR GL0939667 10/01/2009 10/01/2010 _EACH OCCURRENCE 1000.000 DAMAGE TO RENTED PREMSESEac=nvnce $ 1,000,000 MED EXP(Any one person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENERAL AGGREGATE LIMIT APPLIES PER PROPRODUCTS-COMP/OPAL POLICY JECT LOC 2000000 A A AUTOMOBILE X LIABILITY ANY AUTO CA0936289 (ADS) CA6506174(CT) 10/01/2009 10/01/2009 10/01/2010 10/01/2010 COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 A A ALLOWNEDAUTOS SCHEDULED AUTOS CA6506175(MA) CA6506176(VA) 10/01/2009 10/01/2009 10/01/2010 10/01/2010 BODILY INJURY (Per person) $ BODILY INJURY $ X HIRED AUTOS X NON-OWNEDAUTOS (Per accident) X SELF -INSURED FOR PROPERTY DAMAGE (Per accident) $ AUTO PHYSICAL DAMAGE GARAGE LABILITY AUTOONLY-EA ACCIDENT $ ANY AUTO OTHERTHAN EA ACC $ $ AUTO ONLY: AGG EXCESS UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ B WORKER COMPENSATION AND WC4289042(ADS) 10/01/2009 10/01/2010 X IWC STATU- OTH- S 8 A EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/NC4289044 -OFFICERIMEMBEREXCLUDED? (Mandatory In NH tf yes, describe under SPECIAL PROVISIONS tel WC4289043(CA) (FL) �WyC4289045(OR) 10/01/2009 10/01/2009 10/01/2009 10/01/2010 10/01/2010 10/01/2010 --TDE E.L. EACH ACCIDENT 1,000,000 .LDISEASE -EA EMPLOYE $ 11000,000 .L. DISEASE -POLICY LIMIT $ 1,000,000 OTHER B Workers' Compensation/EL WC4289046 (TX) 10/01/2009 10/01/2010 Each AcGEmp/Policy Limit $1,000,000 A A Workers' Compensation/EL XS Workers'Compensation/EL WC4289047 (ND OH WI WY) XWC0899047(WA) 10/01/2009 10/01/2009 10/01/2010 10/01/2010 Each AcGEmp/Policy Limit $1,000,000 Excess of $1,000,000 SIR $1,000,000 DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS RE: P871 RENEWAL. SERVICE AGREEMENT TO PROVIDE MAINTENANCE OF EQUIPMENT & SOFTWARE FOR CUSTOMER -PROVIDED EQUIPMENT AT VARIOUS BUILDING LOCATIONS. THE CITY OF FORT COLLINS, ITS OFFICERS, AGENTS & EMPLOYEES ARE ADDITIONAL INSUREDS PER THE GENERAL LIABILITY BLANKET ADDITIONAL INSURED ENDORSEMENT AS RESPECTS THEIR INTEREST IN THE OPERATIONS OF THE NAMED INSURED AS REQUIRED BY WRITTEN CONTRACT. CERTIFICATE HOLDER SEA-001334072-06 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THEi CITY OF FORT COLLINS PURCHASING EXPIRATION DATE THEREOF, THE ISSUING INSURER WALL ENDEAVOR TO MAIL 215 NORTH MASON, 2ND FLOOR P.O. BOX 580 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, FORT COLLINS,I CO 80522 BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY HIND THE INSURER, ITS AGENTS OR REPRESENTATIVES. TU{PON pqE Oteryll L. &t"to� ,6 �� Cheryl) L. Koch �-V�-�1.t� Koch ACORD 25 (2009/01) ©1998.2009 ACORD CORPORATION. All Rights Reserved The ACORD name and logo are registered marks of ACORD 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 This Certificate of Insurance 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.