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HomeMy WebLinkAbout114340 CUSTOM SERVICES OF COLORADO INC - INSURANCE CERTIFICATE (3)A ^r%L']A `"`'Wr"' CERTIFICATE OF LIABILITY INSURANCE D / o1/02/oz/2013o13 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 CONTACT NAME:ME:Karole Peters Ewing -Leavitt Insurance Agency ja"CDNo,E,0:970.679.7355 �A/CC,No):866.237.2178 ADDRESS: karole-peters@leavitt.com 4025 St. Cloud Dr. Suite 100 Loveland, CO 80538 LW PRODUCER 00000549 CUSTOMER ID k: INSURERS) AFFORDING COVERAGE NAICN INSURED INSURER A: Secura Insurance 22543 Custom Services of Colorado, Inc. INSURER : Plnnacol Assurance 41190 2305 WCR 32 INSURERc: Mead, CO 80542 INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 13-14 WC Renewal 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 TYPE OF INSURANCE ADDL INSR SUBR WVD POLICYNUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DO/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 111 OCCUR X Blkt Addtl Insured 20-TC-0003160361-2�03129I2012 03129/2013 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ ZOO, OOO MED EXP (My one person) $ 5,00 PERSONAL B ADV INJURY $ 1,000,00 X Blkt Waiver of Sub GENERAL AGGREGATE $ 2,000,00 GENT AGGREGATE LIMIT APPLIES PER: POLICY X JET n LOG PRODUCTS - COMP/OP AGG $ 2,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NONOWNED AUTOS 20-A-003160362-2 0312912012 03/29/2013 COMBINED SINGLE LIMIT (Ea accident) S 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ $ A X UMBRELLA LIAR EXCESS LIAR X OCCUR CLAIMS -MADE 20-CU-003160363-2:0312912012 03/29/2013 EACHOCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 DEDUCTIBLE RETENTION $ 10,000 $ X $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 402555501101/2013 BLANKET WAIVE OF SUBROGATIO 01101/2014 X TORYLIMITS �R E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - FA EMPLOYE $ 1,000,00 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) ity of Ft. Collins is shown as additional insured as respects General Liability City of Ft. Collins 256 W. Mountain Avenue P. 0. Box 580 Ft., Collins, CO 80522-0580 V NIYVCLLMI IVIY 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 . J Karole ©1988-2009 ACORD CORPORATION. All ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD