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HomeMy WebLinkAbout129729 EXODUS MOVING & STORAGE INC - INSURANCE CERTIFICATE (9)EXODU-1 OP ID: JD ,d►�oRo CERTIFICATE OF LIABILITY INSURANCE DnrE 1 09/09/13vY) 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 endorsements . PRODUCER Phone:970482-7747 CONTACT NAME, Brown & Brown Inc Fax: 970-484-4165 4532 Boardwalk Dr, Suite 200 PHONE FAX lac No Ertl: I INC, No): Fort Collins, CO 80525 Karen E. Siwek, CPA EMAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIL p INSURERA:Vanllner Insurance Comps 21172 INSURED Exodus Moving and Stora a INSURER B: Pinnacol Assurance Company 41190 Inc' 1730 E Prospect Rd Ste 102 INSURER C Fort Collins, CO 80553 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MMIDDY LTR IYYYY MM/DDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE Is 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ITOCCUR CGV427280300 09/01113 09/01/14 DAMAGE TO RENTED PREMISES Ea occurrence S 100,00 MILD EXP(Any one person) $ 5,00 PERSONAL &ADV INJURY $ 1,000,00 GENERALAGGREGATE $ 2,000,00 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00 POLICY PRO LOD $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accitlent $ 1,OUD,DD BODILY INJURY(Per person) $ A X ANY AUTO TRV427280300 09/01/13 09/01/14 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accitlent $ $ UMBRELIALIAB X OCCUR EACH OCCURRENCE $ 1,000,00 ryll AGGREGATE $ 1,000,00 A EXCESS LIAR CLAIMS -MADE UMV427280800 09/01/13 09101114 OLD I X ftETENTIDN E D S B WORKERS COMPENSATION EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? (Mandatory in NH) NIA 4082858 09/01/13 09/01/14 X WC STATU- DER YITy 14 RR E.LEACHACCDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 It yes. despnoo under DESCRIPTION OF OPERATIONS below E. L. DISEASE -POLICY LIMIT I $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) City of Fort Collins and its elected & appointed officials & employees are included as additional insureds as their interests may appear on the general liability & auto liability if required by written contract. Waiver of subrogation applies on the workers compensation if required by written contract per form 359b FORTCOL 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 Y4. - vJ„%,&-\ © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD