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HomeMy WebLinkAbout486364 INTEGRA TELECOM INC - INSURANCE CERTIFICATE (2)A�-DIZO® CERTIFICATE OF LIABILITY INSURANCE- DATE 07/20/YYYY) tvm/zo1z 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, ANDTHE CERTIFICATE HOLDER. 1. - - - — IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditlons 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 MCGdft, Sabots 8 Williams of Oregon 1800 SW First Avenue, Suite 400 CONTACT NAME: PNONE 5039436621 F'ix 503-943-6622 N - - A/C No Portland, OR 97201 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAICA INSURER A:AdanticSpecialty Insurance Company 27154 INSURED Integra Telecom, Inc. INSURERS: INSURER C : 1201 NE Lloyd Boulevard Suite 500 Portland, OR 97232 INSURER D INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER:WQAZZZDZ 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 TYPE OF INSURANCE INSR WD POLICY NUMBER POLIC EFF MMIDD/YYYY P LY XP MMIDD LIMITS A GENERAL LIABILITY 711-00-91-49-0006 1211512012 12/15/2013 EACH R $ 1,000,D00 X COMMERCIAL GENERAL LIABILITY ' -CLAIMS-MADE FX] OCCUR UAGE70ENTE1 PREMISES Es occurrence $ - 500.000 MED EXP (Any one person) $ 10,000 PERSONAL B'AM INJURY $- 1,000,000 GENERAL AGGREGATE- : $ 2,000,000 - GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ _ 2,000,000 POLICY PRO- X LOG $ - A AUTOMOBILE LIABILITY 711-00-9149-0006 12/15/2012 12/15/2013 COMBINED SINGLE LIMIT Ea accident 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident ) $ HIRED AUTOS NAOTOOWNED PROPERTYdocidatDAMAGE $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DEO RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- _ _ AND EMPLOYERb-LIABILITY_YIN ANY PROR/PARTNER/E%ECUTIVE OFFICERIRIfIEM MEMBER EXCLUDED? NIA 1 _ E.L. EACH ACCIDENT _ $ E.L.NHI DISEASE - EA EMPLOYEE $ (IAandatoryie If yes, describe under E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS be. S S $ DESCRIPTION OF OPERATIONS / LOCATIONS (VEHICLES fARach ACORD 101, Additional Remarks Schedule, If more apace Is required) Re: network services contract Certificate Holder is named as an Additional Insured as respects the operations of the Named Insured with respects to General and Auto Liability Coverage as required by written and signed Contract subject to policy terms, Conditions, limits and exclusions. 61=11I 11-16Al a nvl_UtH CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins AUTHORIZED REPRESENTATNE Box 580 Fort Fort Collins, CO 80522 Page 1 of 1 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Al �® .CERTIFICATE OF LIABILITY INSURANCE °"1ti07/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS - r 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 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 endomement(s). PRODUCER McGnff, Seibels 8 Williams of Oregon 1800 SW First Avenue, Suite 400 CONTACT NAME PNONE FAX C No Exit' 503-943-6621 uC Ne:503-943-6622 Portland, OR 97201 EMAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIL$ INSURER A:Atlantic Specialty Insurance Company 27154 INSURED Integra Telecom, Inc. INSURER B : INSURER C: 1201 NE Lloyd Boulevard Suite 500 Portland, OR 97232 INSURER 0, INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER:A9Q41-cBQ 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 UP TYPE OF INSURANCEAODLSUBRJ POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY UP MMIDDIYYYY LIMITS A GENERAL LIABILITY 711-00-91-49-0006 12/15/2012 12I15/2013 EACH OCCURRENCE $ 1,000,000 PREMISES Ea oaumx. $ - 500,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE' 7X OCCUR MED UP (A,.. person) $ 10,000 PERSONAL S AW INJURY.- $- _ 1.000,000 GENERAL AGGREGATE $ 2,000,000 ' GEN'L AGGREGATE LIMITAPPLIES PER: - PRODUCTS - COMP/OP AGG $ 2,000,000 - POLICY PRO- X LOG liEcT $ A AUTOMOBILE LIABILITY 711-00-9149-0006 12J15/2012 12/15/2013 COMBINED SINGLE LIMIT 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS 1HIRED BODILY INJURY(Per ao ident) $ NON -OWNED AUTOS AUTOS PROPERTY DAMAGE Per accident $ 8 UMBRELLA LIAB OCCUR EACH OCCURRENCE E AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEO I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYER S'LIABILITY YIN - E.L. EACH ACCIDENT $ MYPROPRIETORIPARTNERIEXEOUTIVE OFFICERITAEMBER EXCLUDED? NIA E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NHl If yes. describe under DE ins,OF OPERATIONS below E.L. DISEASE -POLICY LIMIT It $ $ $ E DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ANach ACORD 10f, ACdltlonal RemerkF Schedule, If man apaw le raeulnd) Re: City of Fort Collins BID 7176 -Telephone Lines for City of Fort Collins" Certificate Holder is named as an Additional Insured as respects the operations of the Named Insured with respects to General and Auto Liability coverage as required by written and signed contract subject to policy terms, Conditions, limits and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATETHEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Collins AUTHORIZED REPRESENTATIVE 58 PO Box 580 Fort Collins, CO 80522 Page 1 of 1 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD