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HomeMy WebLinkAbout458840 C & S SPECIALTY SYSTEMS INC - INSURANCE CERTIFICATE (6)'`� b® CERTIFICATE OF LIABILITY INSURANCE 8/7/201z"""' 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 Colorado BW Insurance Agency, Inc. PO BOX .3849 Evergreen CO 80437 CONTACT Johns Moors NAME: PHONE (303)674-5501 FAXMIC No Fail-MIC Not. 130316]9-35]1 E-MAIL .johna.moors@bankofthewest.COM INSURER(SI AFFORDING COVERAGE NAIC 0 INSURER A:Scottsdale Ins Cc INSURED U C & S Specialty Systems Inc. 5609 W 6th Ave., Unit B Lakewood CO 80214 INSURERB:State Auto Insurance Companies INSURER C:Pinnacol Assurance 41190 INSURER D: INSURER E 1 INSURER F: r:r3VFRAr:FC r.FRTIFIr:ATF NIIMRFR-2012-2013 RFVlgln Ki NI IMRFP- 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 POLTYPE POLICY LTR OF INSURANCE POLICY NUMBER MMDIDNYYY MMDDNYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea cocurence $ 100,000 A CLAIMS -MADE OOCCUR PS1546090 /8/2012 /8/2013 MED EXP (My we person) $ 5,000 PERSONAL B ADV INJURY $ 1, 000,000 GENERAL AGGREGATE $ 2,000,000 GEN1 AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $ Include POLICY X I PRO-LOC $ AUTOMOBILE LIABILITY TOMB NEEDI SINGLE LIMIT 1 000,000 BODILY INJURY (Per person) $ B X ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS PROPPERTY DAMAGE AP222069304 /1/2012 /1/2013 HIRED AUTOS A0TOSANED cide Uninsured motorist Blsplit limit $ 1,000,000 00 X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 4, 000, 000 AGGREGATE $ 4,000,000 A EXCESS LIAB CLAIMS -MADE DED XI RETENTION$ 10, ODC $ XBS0020409 /8/2012 /8/2013 C WORKERS COMPENSATION XI WC STATU- OTH- ER AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE❑ E.L. EACH ACCIDENT $ 1 000 000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) NIA 143782 /1/2012 /1/2013 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If descries under na. DE SCRIPTION OF OPERATIONS below E.L. DISEASE. POLICY LIMIT $ 1,000,000 A Professional Liability PS1546090 /8/2012 /812013 $1000, 000 Ccc 2,00D.000 Agg H Rented/Leased Equipment PP29fi629fi09 /1/2012 /1/2013 $25,000 DESCRIPTION OF OPERATIONS I LOCATIONS I 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 Moore/EVEJM 9-��'�-/�— a• '"�—a. a"'<--�-- ACORD 25 (2010105) © 1988-2010 ACORD CORPORATION. All rights reserved. INS025 (201005).01 The ACORD name and logo are registered marks of ACORD