HomeMy WebLinkAbout167490 PEAK AUDIO VISUAL DBA CCS PRESENTATION SYST - INSURANCE CERTIFICATE (2)UI' IU: 1K
ATE (MMIDYY)
,acoRO CERTIFICATE OF LIABILITY INSURANCE D01123/2 Y014
01123/24
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 CONTACT
NAME:
Carver and Associates PHONE PAX
7710 Ralston Road A/Cye E>e1;. ac Ne:
Arvada, CO 80002 EApIRFss: _
INSURED Peak Audio Visual dba INSURERA:Travelers Indemnity of America 36161
CCS Presentation Systems 16700 INSURER B:
700 West Mississippi Ave., A-6
INSURER e:
Denver, CO 80223
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
mmlwu
POLICY NUMBER
M UCY EFP
MI EXP
LIMITS
A
GENERAL LABILITY
X COMMERCIAL GENERAL LIABILITY
CIAIMSMADE �X OCCUR
BB065408135
02/781Z014
02118=15
EACH OCCURRENCE
$ 1,000r
PREMISES Ea omenaKaI
S 300r
MEDEXP(AM " )
S 5. 001
PERSONAL S ADV INJURY
$ 1,000,
GENERAL AGGREGATE
S 2,000,0011
GEN'L AGGREGATE
POLICY
LIMIT APPLIES PER:
X JECT 1 PRo- LOC
PRODUCTS - COMPIOP AGG
$ 2,000,60
$
A
AUTOMOBILE
LABILITY
ANY AUTO
ALLOWNEDAUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
680664OB135
OVIV2014
02/18/2015
COMBINED SINGLE LIMIT
(Ea accident)
S 1,000,06
BODILY INJURY (Pw pereon)
$
BODILY INJURY (Par amidnt)
$
PROPERTY DAMAGE
(PER ACCIDENT)
$
X
X
$
S
A
UMBRELLA LURE
EXCESS LAB
X
OCCUR
CLAIMS -MADE
CUP0578T235
02/1812014
._._
02H8I2015
EACH OCCURRENCE
S 4,000,00
AGGREGATE
$ 4,000,00
DEDUCT
RETENTION $
$
$
WORKERS COMPENSATION
AND EMPLOYERS' LABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE YIN
OFFICER/MEMBER EXCLUDED?
(Mandawry In NH)
H yes. desaibe under
DESCRIPTION OF OPERATIONS Belvx
NIA
WCSTATUL,Mrr- OTH-
I
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
5
E.L. DISEASE -POLICY LIMIT
S
A
Business Owners
680654OB136
02/18/2014
02/18/2015
Property 110,364
DESCRIPTION OF OPERATIONS) LOCATIONS I VEHICLES (ASaah ADORD 101, Ade00nal Raab Sw adul% Rrron aPaaa M nqulrod)
Certificate holder, its officers, agents and employeas are additional
insured if required by written contract
FORTC-6
City of Fort Collins
Purchasing and Risk Management
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
U TyaD-ZUUB AGUKU UUKVUKA I wK. All ngnra reserVUU.
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD