HomeMy WebLinkAboutCORRESPONDENCE - RFP - P1135 UNEMPLOYMENT CLAIMS MANAGEMENT (24)CERTIFICATE OF LIABILITY INSURANCE EMPLO 2 DATE (MM/DD/YYYY)
08/20/10
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Madison Insurance Group HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
425 S . Cherry St, #420 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Denver CO 80246
Phone:303-322-0800 Fax:303-322-0874 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Sentinel insurance Company, Lt 11000
EmpINSURER B: Hartford Insurance Company 0006
Ste
119rs Edge, LLC INSURER C: Philadelphia Insurance Cos 006
2755 S1S Locust St INSURER D:
Denver CO 80222
I INSURER E:
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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.
IMH
LTR
OWUN
INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MM/DD/YYYY
POLICY EXPIRATION
DATE MM/DD/YYYY
LIMITS
B
X
.
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE FX] OCCUR
34SBARV1642
'
06/01/10
06/01/11
EACH OCCURRENCE
$ 1, 000, 000
PREMISES(Eaoccurence)
$ 300, 000
MED EXP (Any one person)
$ 10, 000
PERSONAL & ADV INJURY
$ 1, 000, 000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X ' POLICY PRO- LOC
JECT
PRODUCTS - COMP/OP AGG
s2,000,000
B
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
34SBARV1642
-
06/01/10
06/01/11
-
CO accident)
(EaCOMBINEDSINGLELEUMm "
$ 1000000
BODILY INJURY
(Per person)
$ _
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT.
-.$ -
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
EXCESS / UMBRELLA LIABILITY
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
EACH OCCURRENCE
$ .
AGGREGATE
$
$
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVP
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
If yes, describe under
SPECIAL PROVISIONS below
TORY LIMITS ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
$
C
OTHER
Professional Liab
PHSD420657
06/01/10
06/01/11
Clms Made 1000000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
ULK I IrIGAI h MULUhH CANCELLATION
City of Ft. Collins
Purchasing Division
215 N Mason, 2nd Floor
Ft Collins CO 80522
ACORD 25 (2009/01)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
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
REPRESENTATIVES.
01988-2009 ACORD CORPORATION" All rinhts rasarvpd
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..
AGUML) ZO (ZUUV1U1)