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��. CERTIFICATE OF LIABILITY INSURANCE
DAT2712011 YYYI
07/712011
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(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
Marsh USA Inc.
CA License #0437153
CONTACT
NAME:
PHONE
IC, N ac No :
1301 5th Avenue, Suite 1900
Seattle, WA 98101-2682
E-NAIL
ADDRESS:
Atbl:Kathy Hadd 2062143119 FaX:2062143483
INSURERS) AFFORDING COVERAGE
NAICIf
INSURER A: National Union Fire Ins Co Pittsburgh PA
19445
J13913-QCC-GAW-11.12 kbh cont none
INSURED CenturyLink, Inc.; Embarq Corporation;INSURER
B: Insurance Company Of The State Of PA
19429
Oweet Communications international Inc.;
INSURER C :
and Any Affiliated, Subsidiary 8 Associated Companies
Including Qwest Communications Company LLC
INSURER 0:
1801 California Street, Suite 1150
INSURER E:
INSURER F :
Denver, CO 80202
COVERAGES CERTIFICATE NUMBER: SEA-002239518-18 REVISION NUMBER:15
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
OF INSURANCE
ADDLTYPE
Im
SUBR
POLICY NUMBER
MMJDDNYY
MM PCI
IDONYY
LIMITS
A
GENERAL LABILITY
X
GL2449509
0710112011
091012012
EACH OCCURRENCE
S 1,000,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE MOCCUR
DAMAGE O RENTED
PREMISES REZE.D nca
$ 1,000,000
MED EXP(Any ogre person)
$ 10,000
PERSONAL a ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE
X POLICY
LIMIT APPLIES PER:
F PRO-jECT F LOC
PRODUCTS - COMP/OP AGO
$ 2,000,000
I $
A
LIABILITY
CA3506364(AOSI
0710112011
09101/2012
COMBINED SINGLE LIMIT
Ea accident
2,000,000
BODILY INJURY(P., person)
$
ANYATOCA3506365(MA)
07/012011
091012012
AU
ONEDSCHEDULEDCA3506366(CT)
UTOAUTOSA
071012011
0910112012
FMOBILE
BODILY INJURY(Per acdtlent)
$
X NONOWNEOCA350fi367
IRED AUTOS AUTOS
(VA)
071012011
09/012012
PROPERTY DAMAGE$
Poracckenl
$
Auto Physical Damage - Sell Insured
UMBRELLA LAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LAB
CLAIMS -MADE
DED I I RETENTIONS
$
B
WORKERS COMPENSATION
WC015883725 (ADS)
071012011
07/01/2012
X I we STATU- oTH-
B
A
AND EMPLOYERS' LABILITYCRYB ANY PROPRIETOR/PARTNER/EXECUTNE YIN
OFFICER/MEMBER EXCLUDED?
(Myandatory In NH)
DESCRIPTION OF OPERATIONS Eelow
NIA
WC015883725(CA)
WC015883727 FL
( )
WC015883728 (MA OH WI WY)
07/01/2011
07/0112011
07/0112011
071012012
071012012
07/0112012
E.L. EACH ACCIDENT
$ 1,000,000
E.L. OISEASE-EA EMPLOYE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000.000
A
XS Workers'CompensatioNEL
XWC1192417(WA)
07101/2011
07101/2012
Excess of $1,000,000 SIR $1,000,000
A
XS Workers' CompensationdEL
XWC1192419 (OH)
071012011
07101/2012
Excess of $1,000,000 SIR $1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (A1bch ACORD 101, AddMomi Remarta SC dule, N more specs Is required)
E: BACKUP FOR CITY ON NORTEL EQUIPMENT MAINTENANCE (P871). THE CITY, ITS OFFICERS, AGENTS AND EMPLOYEES ARE ADDITIONAL INSUREDS PER THE GENERAL LIABILITY BLANKET
DDRIONAL INSURED ENDORSEMENT AS RESPECTS THEIR INTEREST IN THE OPERATIONS OF THE NAMED INSURED AS REQUIRED BY WRITTEN CONTRACT.
CITY OF FORT COLLINS
ATTN: JERI MAEL
PO BOX 580
FORT COLLINS, CO 00522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORQED REPRESENTATIVE
of Marsh USA Inc.
Cheryll L. Koch
k2la�
TION. All Halite reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD