HomeMy WebLinkAbout114340 CUSTOM SERVICES OF COLORADO INC - INSURANCE CERTIFICATE (6)ACORD. CERTIFICATE OF LIABILITY INSURANCE
DATE/D014)
12/22/2014
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
Ewing -Leavitt Insurance Agency
402S St. Cloud Dr.
Suite 100
Loveland, CO 8OS38
CONTACT
NAME: Karole Peters
AX
NNE. C;970.679.7355 AC,No;866.237.2178
n uRIESs: karole-peters@leavitt.cam
INSURER(S) AFFORDING COVERAGE
NAIC IN
INSURERA: Secura Insurance
22543
INSURED Custom Services of Colorado, Inc.
PO BOX 800
Mead, CO 80542-0800
INSURER : Pinnacol Assurance
41190
INSURER C:
INSURER D:
INSURER E:
INSURER F
COVERAGES CERTIFICATE NUMBER: 15-16 WC 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 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.
LTR
TYPE OF INSURANCE
INSR
WVD
POLICY NUMBER
MM/DD/YYYY
MMI
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE -XI OCCUR
X Blkt Addl Insured
20-TC-0003160361-
ADDITIONAL INSURED:
ON -GOING OPERATIONS
03/29/2014
03/29/2015
EACH OCCURRENCE
$ 1,000,00
PREMISES Ea occurrence
$ 100,00
MED EXP (Any we person)
$ S,00
PERSONAL BADVINJURY
$ Include
X
Blkt Waiver of Sub
GENERAL AGGREGATE
IS 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER:
17 POLICY X PRO LOC
JECT
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
HIREDAUTOS X AUTOS
20-A-003160362-
03/29/2014
03/2912015
Fadcddent
$ 1, 000, 00
X
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
X
Per accident)M
$
A
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
20-CU-003160363-
03/29/2014
03/29/2015
EACH OCCURRENCE
$ 1,000,00
AGGREGATE
$ 1,000,000
DED X RETENTION$ 10,00
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY OFFICER/MEMBER EXCLUDED ECUTIVr�
(Mandatory in NH)
If y� desc�ee monde.
DESCRIPTION OF OPERATIONS below
N /A
402555501/0112015
BLANKET WAIVE
OF SUBROGATIO
0110112016
X TORV LIMITS ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOI
$ 1,000,00
E.L. DISEASE -POLICY LIMIT
I $ 1,000,00C
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD tot, Addltlonal Remarks Schedule. If more space is repulred)
ity of Ft. Collins is shown as additional insured as respects General Liability
City of Ft. Collins
256 W. Mountain Avenue
P. 0. Box 580
Ft., Collins, CO 8OS22-OS80
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 . J
Karole
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