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HomeMy WebLinkAboutSECURITY DOCUMENT DESTRUCTION - INSURANCE CERTIFICATE (4)ACOR.p. CERTIFICATE OF LIABILITY INSURANCE OPID P SECURID DATE(MMIDD YVYV) 09/30/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Brown & Brown Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 125 S Howes, 5th Floor P O Box 2226 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. I Fort Collins CO 80522-2226 Phone: 970-482-7747 Fax: 970-484-4165 INSURERS AFFORDING COVERAGE ;NAH, INSURED INSURER A: Mountain States Mutual 14648 INSURER B: Pinnacol Assurance Company 41190 Security Document Destruction National. Recycling Inc DBA PO BOX 2472 Ft Collins CO 80522-2472 INSURER .. INSURER D -- -- --- --- ----- -- INSURER E: COVERAGES 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 INSRgDD'4 - (POLICY EFFECTIVE ]POLICY EXPIRATION --- LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATEIDDIYV MMDATE MMIDD/YV LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 , 000 , 0O0 A X (X i COMMERCIAL GENERAL LIABILITY CPP011394603 11/21/08 11/21/09 ' DAMAGETO RENTEDPREMISES(Eaoccurence)_ J $ 100,_000 CLAIMS MADE ! X j OCCUR MED EXP (Any one person) $ 1O , D DO PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE $ 1,000,000 j GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY I I PRo j LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 ODD 000 A IX ANY AUTO BAP011394603 11/21/08 11/21/09 (Ea accident) r ALL OWNED AUTOS BODILY INJURY I$ SCHEDULED AUTOS i (Per person) HIREDAUTOS BODILY INJURY $ NON -OWNED AUTOS (Per occident'__ PROPERTY DAMAGE $ I (Per accident) GARAGE LIABILITY AUTO ONLY EA ACCIDENT -_- I $ .. -.. ANY AUTO THAN EAACC OTHER $ AUTO ONLY: AGG IS EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 1 , O DO , 000 A X OCCUR I CLAIMSMADE UMB011394803 ( 11/21/08 11/21/09 AGGREGATE I $ 1,000, 000 .__� _-. $ DEDUCTIBLE ! $ X RETENTION $10000 i$ WORKERS COMPENSATION AND X I TORY LIMITS J ER , B EMPLOYERS' LIABILITY ANY PROPRIETOR/PIEXECUTIVE (4108948 10/01/09 10/01/10 I E.L.EACH ACCIDENT I 1 $ 1,000,000 t - OFFICER/MEMBER EXCLUDED? I E.L.DISEASE - EA EMPLOYEE] $ S,000, DDD de antler lifS yyECIAL I E.L. DISEASE LIMIT i, $ 1 DOD DDD Sixes, PROVISIONS below PRO -POLICY r r OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS City of Fort Collins is included as Additional Insured as respects the operations of the named insured. CFRTIFICATF HOI_I CANCELLATION CITYFI O SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOI DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL City of Fort Collins IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 215 N. Mason St. Fort Collins CO 80521 REPRESENTATIVES. 25 (2001/08) ©ACORD CORPORATION 198E ACOW CERTIFICATE OF LIABILITY INSURANCE OF ID P DATE(MMIDDIYYYY) SECURID 09/30/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Brown & Brown Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 125 S Howes, 5th Floor HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P 0 Box 2226 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fort Collins CO 80522-2226 Phone:970-482-7747 Fax:970-484-4165 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Mountain St at es Mutual 14648 INSURER8 pinnacol Assurance Company 41190 Security Document Destruction National Recycling Inc DBA INSURERC ... _.. PO BOX 2472 Ft Collins CO 80522-2472 INSURERD - INSURER E: COVERAGES 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'(nO0'IJ -- - - POLICV NUMBER POLIE(MMID FYYV POLICY JMMIDDNION �� LIMITS LTR INSR�LII TYPE OF INSURANCE DATE MMIDD/VV DATE MMIDDIYY GENERAL LIABILITY 1 EACH OCCURRENCE I $1,000,000 A j X COMMERCIAL GENERAL LIABILITY CPP011394803 11/21/08 11/21/09 j DAMAGE TO RENTED PREMISES (Ed occurence)_ $ 100,000 CLAIMS MADE I._x_.00CUR IMEDEXP (An yone person)_ $10,000 PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE I$1,000,000 _.. _ GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG I $ .I POLICY ...,... PROLOC CT AUTOMOBILE �X„i LIABILITY 11/21/08 11/21/09 COMBINED SINGLE LIMIT (Ed accident) $1,000,000 A ANY AUTO BAP011394803 ALL OWNED AUTOS I BODILY INJURY $ j SCHEDULED AUTOS (Per person) HIREDAUT03 (I BODILY INJURY $ NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EAACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY. AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $1, 000,000 A XOCCUR CLAIMS MADE UMB011394803 11/21/08 11/21/09 1 AGGREGATE $1,000,000 $ j DEDUCTIBLE _ $ 1X RETENTION $lO,000 I$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITV HH X W fORV LIMITS I _ ER B ANY PROPRIETOR/ PARTNER/EXECUTIVE 4108948 10/01/09 10/01/10 E.L.EACH ACCIDENT $ 1,000,000 -- OFFICER/MEMBER EXCLUDED? E L DISEASE - EA EMPLOYEE I $ 1,D00,000 fixes , describe under SECIAL PROVISIONS below E.L. DISEASE - POLICV LIMIT -' $1, 000,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION FTCPURC 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 DO SO SHALL City of Fort Collins 215 N Mason IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Fort Collins CO 80522 REPRESENTATIVES. APTHOO;Ep REPRESENTATI /J ACORD 25 (2001/08) © ACORD CORPORATION 1988