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HomeMy WebLinkAbout114340 CUSTOM SERVICES OF COLORADO INC - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE I DATE(MM/DD/YYYY) M 12/29/2010 PRODUCER 970.679. 7333 FAX 866.456.4265 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Ewing -Leavitt Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 4025 St. Cloud Dr. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 100 Loveland, CO 80538 INSURERS AFFORDING COVERAGE NAIC # INSURED Custom Services of Colorado, Inc. INSURER A: Secura Insurance - - -- G9407 _ 796 Abrams-Wy. INSURER : Pinnacol Assurance_ 41190 Lovel and,-- CO 80537 INSURER a -- 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. INSR LTR ADD'L NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YYYY POLICY EXPIRATION DATE MMIDD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE F_x1 OCCUR X I Bl kt Add' l Ins 20-TC-0003160361 PER WRITTEN AGREEMENT 03/29/2010 03/29/2011 EACH OCCURRENCE $ 1,000,000 DPREMISESS AMAGE( RENTED Ea occurrence)$ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL a ADV INJURY $ 1,000,000 X1 Bl kt Wvr of Subro GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO1-1 LOC PRODUCTS - COMP/OP AGG $ 2,000,000 A - AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NONOWNEDAUTOS 20-A-003160362 03/29/2010 03/29/2011 __ -- COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) - $ X BODILY INJURY_._ (Per accident) X PRO PERTY.DAMAGE. (Per accident) - GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ A EXCESS / UMBRELLA LIABILITY X OCCUR E CLAIMS MADE DEDUCTIBLE X RETENTION $ 10 , 00 20-CU-003160363 03/29/2010 03/29/2011 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Or FILER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under SPECIAL PROVISIONS below 4025555 - 01/01/2011 01/01/2012 X I oRY L MITS I°ER E.L. EACH ACCIDENT $ 1,000.000 --- -- E.L. DISEASE - EA EMPLOYEE $ 1 , 000, 000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS GERTIFIGATE HOLDER CANCELLATION City of Fort Collins James L. Hume, Acting Director Director of Purchasing & Risk Mgmt. PO Box 580 Fort Collins, CO 80522-0580 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. AUTHORIZED REPRESENTATIVE Dianne Littlefield/DEL '_/ © 1988-2009 ACORD CORPORATION_ All rinhts rPSPrvPd_ The ACORD name and logo are registered marks of ACORD ACORD CERTIFICATE OF LIABILITY INSURANCE (MMIDD/YYYY) DATE12/z9/2o10 PRODUCER 970.679. 7333 FAX 866.456.4265 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Ewing -Leavitt Insurance Agency 4025 St. Cloud Dr. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 100 Loveland, CO 80538 INSURERS AFFORDING COVERAGE NAIC # INSURED .Custom Services of Colorado, Inc. INSURER A: Secura Insurance G9407 796 Abrams Wy - INSURERB: Pinnacol Assurance 41190 Lovel and ,-_,C_ 0.- 8053 7 . _ INSURER C: INSURER D: - INSURER E - COVERAGES.,: THE POLI%S'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 NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YYYY POLICY EXPIRATION DATE MMIDD/YYYY LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE I OCCUR IX Bl kt Add' l Ins 20-TC-0003160361 PER WRITTEN AGREEMENT 03/29/2010 03/29/2011 EACH OCCURRENCE $ 1,000,000 DAMAGE RE PREM SESOEaNcurrDence $10U,000 MED EXP (Any one person) $ 5,000 PERSONAL a ADV INJURY $ 1,000,000 Bl kt Wvr of Subro GENERAL AGGREGATE $ 2,000,000 _X_1 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOC JECT PRODUCTS - COMP/OP AGG $ 2,000,000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS . . - NON -OWNED AUTOS 20-A-003160362 -' 03/29/2010 -' _. , 03/29/2011 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X 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 $ $ A EXCESS / UMBRELLA LIABILITY X OCCUR CLAIMS MADE XIDEDUCTIBLE$ X RETENTION $ 10 , 00 20-CU-003160363 03/29/2010 03/29/2011 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER MEIN GOER/EXCLUDR/ XECUTIVE�� (Mandatory in NH) If yes, describe under SPECIAL PROVISIONS below 4025555 _ 01/01/2011 _ 01/01/2012 _ X I ORYLMTS I I ER E.L. EACH ACCIDENT - -'" $ 1','000 , 000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ity of Ft. Collins is shown as additional insured. CERTIFICATE HOLDER CANCELLATION City of Ft. Collins 256 W. Mountain Avenue P. 0. Box 580 Ft. Collins, CO 80522-0580 ACORD 25 (2009101) 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 Dianne Littlefield/DEL © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD