HomeMy WebLinkAbout125038 H & H DATA SERVICES INC - INSURANCE CERTIFICATE (3)OP ID: SC
144cojzo CERTIFICATE OF LIABILITY INSURANCE
071031 DaT2
07/03/12
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)les) must be endorsed. If SUBROGATIONISWAIVED, subject to,
the terms and conditions of the policy, certain policies may require an endorsement. A statement on thls certificate does not confu rights to the
certificate holder.in lieu of such endorsements . '
PRODUCER - 970-223-18D4
CONTACT
NAME: - - - - - -
Front Range Insurance Group
1100 Haxton Drive Suite 100
PH0PE FAX
AIc No E Arc No:
Fort Collins, CO 80525
David A. Wooldridge LUTCFAAI
SAAR.
ADDRESS.
CUSTOMERIDS:HHELE-1
INSURE S AFFORDING COVERAGE
NAIL/
INSURED H & H Data Services, Inc.
INSURER A:Secura Insurance Companies
22543
Joe Hahn
1310 WebsterAvenue
INSURER B
Fort Collins, CO 80524
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 MAYHAVE BEEN REDUCED BY PAID CLAIMS.
LTR
TYPE OF INSURANCE
2158.
POLICY NUMBER
MMIDD
MMIDDIYVYY
LIMITS
A
GENERALLIABILBY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE FV7
A I OCCUR
X
TC3140442
07/01/12
07/01/13
_
EACH OCCURRENCE
$ 1,000,00
PREMISES Eaoccurrence
$ - 100,000
RED EXP(An one person).
$ 5,000
PERSONAL d ADVINJURY'
$ 1,000,000
X
EPL: $100,000
GENERAL AGGREGATE
$ 21000,000
GEN' L AGGREGATE LI MIT APPLIES PER'.
X POLICY PRO-JECT LOC
PRODUCTS-COMPIOP AGO
$ 2,000,00
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NONOWNEDAUTOS
A3140443
07101/12
07/01/13
COMBINED SINGLE LIMIT
(Ea accident)
S 1,000,00
BODILY INJURY:Per person)
$
BODILY INJURY Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
X
X
$
4
A
UMBRELLA Li
EXCESS Lbi
X
OCCUR
CLAIMSMADE
CU3140444
07/01N2
07/01/13
EACH OCCURRENCE
$ 4,000,00
AGGREGATE
$
DEWCTIBLE
RETENTION $ 10000
$
X
$
WORKERS COMPENSATION
AFD EMPLOYERS' LIABILITY YIN
ANY PROPRIETORIPARTNERIEJECUTIVE r
OFFICERMIEMBER EXCLUDED?
(Mandatory In Ni
If Yes, describe under
DESCRIPTION OF OPERATIONS bolow
NIA
WC STATU_ OTH-
TORY LIMITS ER
E L. EACH ACCIDENT
$
E.L. DISEASE- EA EMPLOYEE
S
E.L. DISEASE -POLICY LIMIT
$
A
A
Business Pers Prop
Floater
TC3140442
TC3140442
07101/12
07/01/12
07l01113
07/01/13
IBPP 71,40
Floater 127,78
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHCLES ((Attach ACORD 101, Additional Rumania, Schedule, It mom apace Is required)
City of Fort Collins is named as additional insured with regards to general
liability as their interest may appear.
CERTIFICATE HOLDER CANCFI I ATION
FORTC-1
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Fort Collins
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
P.O. Box 580
Fort Collins, CO 80522-0580
AUTHORIZEDREPRESENTAWE
a.,,o,O G. c /v.�✓•�
ACORD 25 (2009109)
e01989-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD