HomeMy WebLinkAbout167490 CCS PRESENTATION SYSTEMS - INSURANCE CERTIFICATE (3)OP ID: SR
4�Ro CERTIFICATE OF LIABILITY INSURANCE 1
DATE02104DIYYYY)
2/04/11
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'andlconditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
' .. 1 -
certificate holder in lieu of such endorsement(s). - I ' I - - - I
!PRODUCER _.._ . `. —r-- - _. �. _' 420-1637 - - . __
303
Carver and Associates ' `" 303-431-9237
7710 Ralston Road -... J t r`.e2 r_ i
CONTACT -
.NAME:-
PHONE FAX
Nc No EXI : --INC,No
Arvada, CO 80002 -
Don W Carver
•- -
E-MAIL.
ADDRESS:
PRODUCER '
CUSTOMERID#: CCSPR-2 ,y
INSURER(Sl AFFORDING COVERAGE
NAIL#
INSURED Peak Audio Visual dba
INSURERA:Travelers Indemnity of America
-
INSURER B:
CCS Presentation Systems
699 Bryant Street #100
Denver, CO 80204
INSURER C
INSURER D
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER: 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
rypE OF INSURANCE
ADDL
U
POLICY NUMBER
POLICY EFF
MMIDDIYYYY
POLICY EXP
MM/DDNYYY)
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
DLAIMS.MADE Fx-1 OCCUR
X Blanket Add. Ins.
680654OB135
02/18/11
02/18/12
EACH OCCURRENCE
It 1,000,00
PREMISES Ea occurrence
$ 300,00
MED EXP (Any one person)
$ 5,00
PERSONAL B ADV INJURY
$ 1:000,00
GENERAL AGGREGATE
$ _ 2,000,000
GENL AGGREGATE LIMIT APPLIES PER:
17 POLICY X PRO LOC
PRODUCTS - COMPIOP AGG
It _. 2,000,00
_
$
'•'�
A
AUTOMOBILE
LIABILITY ------- -----
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNEDAUTOS
._.
','
... ."
680654OB135
02/18/11
02/18/12
COMBINED SINGLE_ LIMIT
(Ea accident) -
_
$ .1,000,00.--,
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
X
X
$
A
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
CUP0576T235
02/18111
02/18112
EACH OCCURRENCE
5 4,000,00
AGGREGATE
$ 4,000,00
DEDUCTIBLE
RETENTION It
It
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y/N
ANY PROPRIETORMARTNERIEXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
WCSTATU- UrH-
T R IMIT R
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE -POLICY LIMIT
$
A
Business Owners
680664OB135
02118111
02/18/12
Property 104,03
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
Certificate holder, its officers, agents and employees are additional
insured if required by written contract
FORTC-6
City of Fort Collins
Purchasing and Risk Management
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
1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD