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Home My WebLink About114340 CUSTOM SERVICES OF COLORADO - INSURANCE CERTIFICATEJ"TvWCERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/25/2013 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: Karole Peters Ewing -Leavitt Insurance Agency 'A"cN EsL:970.679.7355 uCNe:866.237.2178 AIL A DRESS: karole-peters@leavitt.com 4025 St. Cloud Dr. Suite 100 Loveland, CO 80538 0 PRODUCER 00000549 CUSTOMER ID p: INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURER A: Secura Insurance 22543 Custom Services of Colorado Inc. INSURERB: Pinnacol Assurance 41190 PO Box 800 INSURER C : Mead, CO 8OS42-0800 INSURERD: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 13-14 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 CONTRACTOR 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 ADDL I N S R SUER WVD POUCYNUMBER POLICY EFF MM/DDM'YY POLICY EXP MMIDD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE III OCCUR X Blkt Addtl Insured 20-TC-0003160361-303/2912013 0312912014 EACH OCCURRENCE $ 1,000,00 DAMAGE TO PREMISES (Ea Eoccunence $ 100,00 MED EXP (Any we person) $ 5,00 PERSONAL B ADV INJURY $ 1,000,00 X Blkt Waiver of Sub GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY FX7 PRO LOC JECT PRODUCTS - COMP/OP AGG $ 2,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON -OWNED AUTOS 20-A-003160362-303/2912013 03129/2014 CO aBINEDl'INGLE LIMIT (EaBODILY $ 1,000,000 X INJURY (Per person) $ BODILY INJURY (Per accident) IS PROPERTY DAMAGE (Per accident) $ X X $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 20-CU-003160363-2 03/29/2013 03/2912014 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,00 HxDEDUCTIBLE RETENTION $ 10,000. S Is B WORKERS AND EMPLOYERS' LIABTLDITY yIN ANY PROPRIETOR/PARTNEWEXECUTIVE❑ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, descnbe under DESCRIPTION OF OPERATIONS below NIA 4025555,01I01I2013 BLANKET WAIVER OF SUBROGATION 01I01I2014 X ORV LAMITS DER E.L. EACHACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT I $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ANach ACORD 101, AddlOonal Remarks Schedule, If more space Is required) ity of Ft. Collins is shown as additional insured as respects General Liability CERTIFICATE HOLDER CANCELLATION City of Ft. Collins 256 W. Mountain Avenue P. 0. Box 580 Ft., Collins, CO 80522-0580 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 ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD