HomeMy WebLinkAbout167490 CCS PRESENTATION SYSTEMS - INSURANCE CERTIFICATE (2)DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE OP ID SR
CCSPR-2 02/11/10
I
Carver and Associates / -
7710 Ralston Road
Arvada CO 80002 MAR 2 2010
Phone:303-420-1'637 Fax:303-431;-9237
INSURED
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699 Bryant Street # FEg 2�1�
--:--Denver CO 80204
COVERAGES'-
II1 tl—," —, L 11 IJJV -1 P11 -I 1 "1, VI. 1— VI\IY1I I -'
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE - NAIC #
II URER A: Travelers Indemnity of America -
1--rail
INSURER B:
INSURER C - _ ._ .. _....
INSURER D:- '
INSURER E:
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.
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MM/DDfYYYY
POLICY EXPIRATION
DATE MMIDDIYYYY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
PREMIS ES(Eao,!urence)
$300,000
A
X COMMERCIAL GENERAL LIABILITY
680654OB135
02/18/10
02/18/11
CLAIMS MADE X� OCCUR
MED EXP (Any one person)
$ 5,000
PERSONAL BADV INJURY
$ 1, 000., 000
X Blanket Add. Ins.
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 2,000,000
POLICY X PRO LOC
JECT
A
AUTOMOBILE
LIABILITY
ANY AUTO
680654OB135
02/18/10
02/18/11
COMBINED SINGLE LIMIT
(Ea accident)
$ $1, 000, 000
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
_
X
PROPERTY )DAMAGE
accident)
$ _
...
..'.•'.,_.:.
_ -
- - - - -
,..-,.. ....,... ..
GARAGE LIABILITY
- -
AUTO ONLY - EA ACCIDENT
$
EA ACC
OTHER THAN
$
ANY AUTO ___. .. ._._..._
._ .. _ ..
.. ..
.
., ...; -
$ _ ..
.. -
.. _ - .
_
AUTO ONLY:. - - AGG
EXCESS UMBRELLA LIABILITY
EACH OCCURRENCE
$ $4, 000, 000
A
X I OCCUR ❑ CLAIMS MADE
CUP05767`235
02/18/10
02/18/11
AGGREGATE
$ $4, 000, 000
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION
-
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVEM
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
TORY LIMITS I I ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
If yes, describe under
E.L. DISEASE - POLICY LIMIT
$
SPECIAL PROVISIONS below
OTHER
A
Business Owners
680654OB135
02/18/10
02/18/11
Property $103,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Certificate holder, its officers, agents and employees are additional
insured if required by written contract
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOI
FORTC- 6 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
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
City of Fort Collins .
Purchasing and Risk Mgt AUTHORIZED REPRESENTATIVES.
REPREENTATIVE
P. 0. Box 580
Port Collins CO 80522
ACOR 25 (2009/01) C RATION. Aff-MgRtrivserved.
T.CORD name and logo are registered marks of ACORD