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Home My WebLink AboutQWEST - INSURANCE CERTIFICATE (5)ACC]'Ro ® CERTIFICATE OF LIABILITY INSURANCE DAT22QD14D YYYY 82212014 0 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 Marsh USA Inc. CA License#0437153 CONTACT NAME: PHONE FAX ac No E-MAIL ADDRESS: 1301 5th Avenue, Suite 1900 Seattle, WA 9 682 Attn:: SeaWe.certrequnrequesl@marsh corn I FaX: 212-948-4326 A 3913-CTL-GAWW-14-15 kbh coot INSURERS AFFORDING COVERAGE NAIC C INSURER A: Greenwich Insurance Company 22322 INSURED Centu Owes[ omir Inc.; bons Inmbrant Corporation; Inc.:3�O 0-1 Owes[ QOIrIrrIUNCatrOrIS InlemallIXldl In INSURERS: XL Insurance America, Inc. 24554 INSURER C XL Specialty Insurance Company 37885 INSURER D and All Affiliated, Subsidiary & Associated Companies Including Qwest Government Services, Inc. 1801 California Street, Suite 1150 INSURER E : INSURER F : Denver, CO 80202 COVE GEE C:FRTIFICATF NIIMRFR- SEA-002240696.17 REVISION NUMBER: 19 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, "'SR LTR TYPE OF INSURANCE ADOL UBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY UP MMIDD/YYYY LIMITS A GENERAL LIABILITY X RGD500033302 09101/2014 0910112015 EACH OCCURRENCE $ 1,000,000 DAMAGE TOR D PREMISES Eaoccunence $ 1,000,000 X COMMERCIAL GENERAL LIABILITY MED EXP (Any oneperson) $ 10,000 CLAIMS -MADE 1XI OCCUR PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 $ X RDLICY PRO- LOG J"TA AUTOMOBILE LIABILITY RAD500033402 - ADS 09/01/2014 09101/2015 COMBINED SINGLE LIMIT Ea accident 2,000,000 BODILY INJURY (Per person) $ A X ANY AUTO RAD500033502 - MA 09/0112014 09/01/2015 BODILY INJURY (Per accident) $ X ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED X HIRED AUTOS fX AUTOS Auto Physical Damage- Self Insured PROPERTY DAMAGE Ipdve sm $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAS CLAIMS -MADE LIED RETENTION $ B WORKERS COMPENSATION RWD500032902ADS 09101Y2014 09/0112015 X WCsrATu- orH- B AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER E)(CWDED9 N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS belim N/A RWR500033002 WI 09/01/2014 0910112015 E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000.000 C XS Workers' COmpensationIEL RWE500033102- WA 09/01/2015 Excess of $1,000,000 SIR 1,000,000 C XS Workers' Compensation/EL RWE500033202 - OH r011*1112014 4 0910112015 Excess of$1,000,000 SIR 1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) RE: P871 RENEWAL. SERVICE AGREEMENT TO PROVIDE MAINTENANCE OF EQUIPMENT & SOFTWARE FOR CUSTOMER -PROVIDED EQUIPMENT AT VARIOUS BUILDING LOCATIONS. THE CITY OF FORT COLLINS, ITS OFFICERS, AGENTS & EMPLOYEES ARE ADDITIONAL INSUREDS PER THE GENERAL LIABILITY BLANKET ADDITIONAL INSURED ENDORSEMENT AS RESPECTS THEIR INTEREST IN THE OPERATIONS OF THE NAMED INSURED AS REQUIRED BY WRITTEN CONTRACT. r-OTrorATE HOLDER CANCFI 1 ATICIN CITY OF FORT COLLINS PURCHASING SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 215 NORTH MASON, 2ND FLOOR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O. BOX 580 ACCORDANCE WITH THE POLICY PROVISIONS. FORT COLLINS, CO 80522 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Cheryll L. Koch Ck"-fu• `i 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD