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HomeMy WebLinkAbout129729 EXODUS MOVING & STORAGE INC - INSURANCE CERTIFICATE (10)EXODU-1 OP ID: DA '4`� CERTIFICATE OF LIABILITY INSURANCE DAT09/05D/YYVV) os/os/1a 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: 970-482-7747 Brown 8 Brown Inc 4532 Boardwalk Dr, Suite 200 Fax: 970-4844165 Fort Collins, CO 80525 Karen E. Siwek, CPA CONTACT NAME: also Ne Ea1: ac No: E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC d INSURER A: Vanllner Insurance Company 21172 INSURED Exodus Moving and Storage Inc INSURERB:Pinnacol Assurance Company 41190 1730 E Prospect Rd Ste 102 Fort Collins, CO 80525 INSURER L 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 LTR rypE OF INSURANCE D L SS POLICY NUMBER POLICY EFF MM/DD/YYYV POLICY E%P MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE 1XI OCCUR PKV000021401 09/01/14 09/01,15 DAMAGE TO RENT D PREMISES Ea occurrence $ 100,00 NED EXP (Any one person) $ 10,00 PERSONAL B ADV INJURY $ 1,000,00 GENERAL AGGREGATE E 2,000,000 SENT AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMPIOP AGG IS 2,000,00 POLICY PRO-IFCT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea aco dent E 1,000,00 BODILY INJURY (Per person) $ A X ANY AUTO TRV4272803 01 09/01/14 09/01/15 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident)$ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ E X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 A EXCESS LUIB CLAIMS -MADE UMV427280301 09/01/14 09/01/15 LIED I X I RETENTION$ O $ 1 B WORKERS COMPENSATION IA AND EMPLOYERS' LIABILITY ANY OFFICERIMEMBOERIEXCLUEPME ECUTIVE YIN N/A 4082858 09/01/14 09/01/15 X WC STATU- OTH - T RY LIM T ER E.L EACH ACCIDENT E 1,000,00 EL DISEASE - EA EMPLOYEE $ 1,000,00 (Mandatory, In NH) If yes, descnbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 11000.00 A Hired Auto Phy Dining TRV4272803 01 09/01/14 09101/15 Comp Ded 10 $100,000 Limit Coll Ded 1,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is requlnd) City of Fort Collins and its elected S appointed officials S employees are included as additional insureds as their interests may appear on the general liability S 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 © 1988.2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD No Text