HomeMy WebLinkAbout458840 C & S SPECIALTY SYSTEMS INC - INSURANCE CERTIFICATE (4)AcoR - CERTIFICATE OF LIABILITY INSURANCE
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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).
PRODUCER-. _, - -- ��'_ .__....._ _. ... _.
CONTNAME Evergreen Evergreen CSR
PHON4. EaDt (303)674-5501 jnc
Colorado. .BWt Insurance_,.Agency, Inc.
ADDRESS:
'PO BOX 3849_.._. __._. __
PRODUCER 0002$91O - -
USIOMER.m a
___. _ - -
INSURER(S) AFFORDING COVERAGE' "'
NAIC0 L.
Evergreen CO 80437
INSURED
INSURER A:Scottsdale Ins Cc
-
INSURERB:State Auto Insurance Companies
C & S Specialty Systems Inc
INSURER C Pinnacol Assurance
41190
5609 W 6th Ave., Unit B
INSURER D:
INSURER E
INSURER F:
Lakewood CO 80214
COVFRAGFS CERTIFICATE NUMBER:2011-12 Master REVISION NUMBER:
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OFINSURANCE
ADDLSUBR
POLICY NUMBER
POLICY EFF POLICY EXP
MMIDDNYYY MMIDDNYYY
LIMITS
A
Y
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMSWOEOCCUR
CPS1329980
2/1/2011 /8/2012
EACH OCCURRENCE
S 1,000, 000
DAMi PREMISES RENT re mo
S 100, 000
MED EXP(My one person)
$ 5,000
PERSONAL B ADV INJURY
S 1,000,000
GENERAL AGGREGATE -
$ 2,000,000
;GENT AGGREGATE
X POLICY
LIMITAP,PLIES PER:.
F PRO-' lPrT n LOC---
PRODUCTS-COMPIOP AGG
$ 1-; 000, 000
'
-,
B
AUTOMOBILE
LIABILITK -�-.. _ ..
ANY AUTO' _
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
W - -
_.,
.�
BAP222069302
7/1/2010
.-
7/1/2011
COMBINED SINGLE LIMIT`-
(Ea accident) -
$ 11 000, 000
X
er
BODILY INJURY (Per person)
$
'
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
Uninsured motorist Bl split limit
$ 1,000,000
Underinsured motorist Bl split
$ 1,000,000
A
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
-
BS0012795
2/8/2011
2/8/2012
EACH OCCURRENCE
$ 4:000,000
AGGREGATE
$ 40001000
DEDUCTIBLE
RETENTION $ 10,000
$
X
$
L.
WORKERS COMPENSATION
ANDEMPLOYERS' LIAB ILITY YIN
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
4143782
2/1/2011
2/1/2012
WC STATU- OTH-
TORY LIMITS ER
E.L. EACH ACCIDENT
$ 1 000, 000
E. L. DISEASE - EA EMPLOYE
$ 1 0001200
E. L. DISEASE - POLICY LIMIT
$ 1 000 000
DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace Is required)
City of Fort Collins
P.O. Box 580
Fort Collins, CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Arnpn 95 l9000/nQl
Johna Moors/EVEJM �-^�-�—
rn 9QRR_9nn0 ACnRr1 r.n PPrTRATinpi All rinhfe rocnrvnd
INS025 (2M909) The ACORD name and logo are registered marks of ACORD