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HomeMy WebLinkAbout309950 T2 SYSTEMS INC - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE DAII/23/2O 0 ) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Woodruff -Sawyer & Co. 220 Bush St., 7th Floor ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. San Francisco CA 94104 (415) 391-2141 INSURERS AFFORDING COVERAGE NAIC # INSURED T2 Systems, Inc. 7835 Woodland Drive, Suite 250 Indianapolis, IN 46278 INSURER A: American Casualty Company of Reading P nn 20427 INSURER B: Continental Casualty Company 20443 INSURER c: National Fire Insurance Company of Hartford 20478 INSURER D: INSURER E: CAVFRAnFS 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 ADD'L 19 -TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE DD POLICY EXPIRATION DATE LIMITS C GENERAL LIABILITY B4019982102 01/01/2010 01/01/2011 EACH OCCURRENCE $ 1,000,000 DAMAGE PREMISESS ( RENTED occurence) $ 300,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE 1XI OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY PRO LOC jECT C AUTOMOBILE LIABILITY B4017935476 01/01/2010 01/01/2011 COMBINED SINGLE LIMIT $ X ANY AUTO (Ea accident) BODILY INJURY $ 1,000,000 ALL OWNED AUTOS SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ 1,000,000 X NON -OWNED AUTOS (Per accident) PROPERTYDAMAGE $ (Per accident) _ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 5,000,000 B X OCCUR CLAIMS MADE B4019982150 01/01/2010 01/01/2011 AGGREGATE $ 5,000,000 $ DEDUCTIBLE $ X RETENTION $ 10,000 B WORKERS COMPENSATION AND WC417935493 O1/01/2010 Ol/O1/2011 wcsTIMT TH- CRY IT ER E.L. EACH ACCIDENT $ 500,000 LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYEE $ 500,000 OFFICER/MEMBER EXCLUDED? SPECIAScribe under LPROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER Errors and Omissions 287478713 0 Tff77M 0 Each Claim $ 1,000,000 Fidelity Bond 82226018 08/31/2010 08/31/2011 Retention $ 25,000 Limit g 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS The City of Fort Collins, CO is included as Additional Insured with regards to General Liability, per endorsement to follow. I.CK I IrIk A 1 C r7ULLlCK GAIVIaLLA I IUN IU Lay tNotice ror iNon-raymcrn or rremium City of Fort Collins 215 North Mason P.O. BOX 580 Fort Collins, CO 80522 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 AUTHORIZED REPRESENTATIVE w ACORD 25 (2001/08) ID #: © ACORD CORPORATION 1988 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) A CORD DATE (MM/DD/YYYY) rM CERTIFICATE OF LIABILITY INSURANCE 11/23/2010 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Woodruff -Sawyer & Co. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 220 Bush St., 7th Floor HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. San Francisco CA 94104 (415) 391-2141 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: American Casualty Company of Reading P nn 20427 T2 Systems, Inc. INSURER B: Continental Casualty Company 20443 7835 Woodland Drive, Suite 250 Indianapolis, IN 46278 INSURER c: National Fire Insurance Company of Hartford 20478 INSURER D: INSURER E: rnVFRAnFS 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 ADDT EW OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM DD POLICY EXPIRATION D MM DD LIMITS C -TYPE GENERAL LIABILITY B4019982102 01/01/2010 01/01/2011 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurence $ 300 000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE FRI OCCUR MED EXP (Any one person) $ 10,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY PRO- JECTLOC C AUTOMOBILE LIABILITY B4017935476 01/01/2010 01/01/2011 COMBINED SINGLE LIMIT $ X ANY AUTO (Ea accident) BODILY INJURY $ 1,000,000 ALL OWNED AUTOS SCHEDULEDAUTOS (Per person) X HIRED AUTOS BODILY INJURY $ 1,000,000 X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 5,000,000 B X OCCUR ❑ CLAIMS MADE B4019982150 01/01/2010 01/01/2011 AGGREGATE $ 5,000,000 $ HDEDUCTIBLE $ X RETENTION $ 10,000 B WORKERS COMPENSATION AND WC417935493 O1/01/2010 0(/01/2011 I I ATU- OTH- LIMITS ER E.L. EACH ACCIDENT — $ 500,000 EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYEE $ 500,000 OFFICERIMEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER Errors and Omissions 287478713 1/2010 --61/01/2011 Each Claim $ 1,000,000 Fidelity Bond 82226018 08/31/2010 08/31/2011 Retention $ 25,000 Limit $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS The City of Fort Collins, CO is included as Additional Insured with regards to General Liability, per endorsement to follow. ULKIII-IUAIt NULUtK City of Fort Collins 215 North Mason P.O. Box 580 Fort Collins, CO 80522 GANGtLLA I IUN I U Uay Nonce for Non-rayment of rrcmlum 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. AUTHORIZED REPRESENTATIVE w • A� -� ACORD 25 (2001/08) ID #: ©ACORD CORPORATION 1988 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. AGURD 25 (2UU1/US) ACORD ,M CERTIFICATE OF LIABILITY INSURANCE °11/23/2o o' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Woodruff -Sawyer & Co. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 220 Bush St., 7th Floor HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. San Francisco CA 94104 (415) 391-2141 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: American Casualty Company of Reading P nn 20427 T2 Systems, Inc. INSURER B: Continental Casualty Company 20443 7835 Woodland Drive, Suite 250 Indianapolis, IN 46278 INSURER c: National Fire Insurance Company of Hartford 20478 INSURER D: INSURER E: CAVFRAnFS 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 INSR OF INSURANCE POLICYNUMBER POLICY EFFECTIVE DA DD POLICY EXPIRATION D D LIMITS C -TYPE GENERAL LIABILITY B4019982102 01/01/2010 01/01/2011 EACH OCCURRENCE $ 1,000,000 DAMAGE TO PREM SES (E. occurence)$ 300,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY PRO LOC C AUTOMOBILE LIABILITY B4017935476 01/01/2010 01/01/2011 COMBINED SINGLE LIMIT $ X ANY AUTO (Ea accident) BODILY INJURY $ 1,000,000 ALL OWNED AUTOS SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ 1,000,000 X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 5,000,000 B X1 OCCUR CLAIMS MADE B4019982150 01/01/2010 01/01/2011 AGGREGATE $ 5,000,000 $ DEDUCTIBLE $ X RETENTION $ 10,000 B WORKERS COMPENSATION AND WC417935493 01/01/2010 01/01/2011 - orH- We Y LIMIT srATul ER E.L. EACH ACCIDENT $ 500,000 EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE - FA EMPLOYEE $ 500,000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER Errors and Omissions 287478713 1 1 20 Each Claim $ 1,000,000 Fidelity Bond 82226018 08/31/2010 08/31/2011 Retention $ 25,000 Limit $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS The City of Fort Collins, CO is included as Additional Insured with regards to General Liability, per endorsement to follow. loth( 111-IUA It: MULUtK City of Fort Collins 215 North Mason P.O. Box 580 Fort Collins, CO 80522 LOAN #: CANCtLLATIUN I Uay Notice for Non-rayment of Premium 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. AUTHORIZED REPRESENTATIVE w • AJ .� ACORD 25 (2001/08) ID #: © ACORD CORPORATION 1988 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)