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HomeMy WebLinkAboutQWEST - INSURANCE CERTIFICATE (2)ACORO® CERTIFICATE OF LIABILITY INSURANCE 11i DATE(M 11 YYY) a7272on 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 pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terns 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 Marsh USA Inc. CA License g0437153 CONTACT NAME: PHONE ,1: FAX No): 1301 5th Avenue, Suite 1900 Seattle, WA 98101-2682 EMAIL ADDRESS: Atbr Kathy Hand 206 214-3119 Fax:206214-3483 INSURER 9 AFFORDING COVERAGE NAIL 0 INSURER A: National Union Fire Ins Co Pittsburgh PA 19445 J13913-OGS-GAW-11-12 kbh mnt none INSURED CenturyLink, Inc.; Embarq Corpora0on; INSURER B: Insurance Company Of The State Of PA 19429 INSURER C Oldest Communications International Inc.; and All Affiliated, Subsidiary 8 Associated Companies Including Qwest Government Services, Inc. INSURER D : 1801 California Street Suite 1150 INSURER E : INSURER F : Denver, CO 80202 COVERAGES CERTIFICATE NUMBER: SEA-002240696-09 REVISION NUMBER: 17 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 OF INSURANCE ADD LZ R IWDPOUCYNUMBER POUCYEFF MWDD POLICYEXP MWOD UNITS; A GENERAL LIABILITY X GL2449W9 07/012011 09/012012 EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL Lh1BILITY CLAIMS -MADE rq OCCUR MAZEMRENT�U PREMISES Ea cocunenm $ 1,000,000 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 AGO f 2,000,000 EPOLICY F7 PRO LCC s A AUTOMOBILE MBILm CA3506364 (ADS) 07/01/2011 09/01/2012 COMBINED SINGLE LIMIT Ee ecc'. 2,000,000 X BODILY INJURY (Per person) $ A ANY AUTO CA3506365(MA) 0710112011 09/01I2012 A ALL OWNED SCHEDULED AUTOS AUTOS CA3506366(CT) 07/0112011 09101/2012 X BODILY INJURY Per accident ) $ A X NON-0WNED HIRED AUTOS X AUTOS CA35063fi7 (VA) 07/0112011 09101/T012 PROPERTY DAMAGE Peraocident $ $ Auto Physical Damage - SeO Insured UMBRELLA LAB OCCUR EACH OCCURRENCE E AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTIONS $ B WORKERS COMPENSATION WC015883725 (AOS) 0710112B11 071012012 X WC STATU- oTH- B B B AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTNE YIN OFFICER/MEMBER EXCLUOE07 (MyyaeendaWsy In NM) DESCRIPTION OF OPERATIONS bebw N/A WC015883726(CA) WC015883727 (FL) WC015883728 (MA OH WI WY) 07101/2011 07/0112011 0710112011 07/01/2012 07/012012 07/0112012 I E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE- EA EMPLOYEE $ 1,000,000 E.L. DISEASEPOLICYLIMIT f 1,000,000 A Workers'Compensabon/EL XWC1192417(WA) 1711112111 /71012012 Excess of$1,000,DOO SIR $1,000,000 �XS A XS Workers'CompensationlEL XWC1 192419 (OH) 071012011 07/012012 Excess of $1,000,000 SIR $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Addmomi Remarks SC dine, U more specs Is "ulred, E: P871 RENEWAL. SERVICE AGREEMENT TO PROVIDE MAINTENANCE OF EQUIPMENT 8 SOFTWARE FOR CUSTOMER -PROVIDED EQUIPMENT AT VARIOUS BUILDING LOCATIONS. THE CITY OF ORT COLLINS, ITS OFFICERS, AGENTS 8 EMPLOYEES ARE ADDITIONAL INSUREDS PER THE GENERAL LIABILITY BLANKET ADDITIONAL INSURED ENDORSEMENT AS RESPECTS THEIR INTEREST IN THE OPERATIONS OF THE NAMED INSURED AS REQUIRED BY WRITTEN CONTRACT. CITY OF FORT COLLINS PURCHASING 215 NORTH MASON, 2ND FLOOR 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 of Mani USA Inc. Cheryl L. Koch [ek—III yr) ,YOGA_ AL:UKU ZO (ZUTU/UO) © 1988-2010 ACORD The ACORD name and logo are registered marks of ACORD reserved.