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HomeMy WebLinkAboutCUSTOM SERVICE OF COLORADO - INSURANCE CERTIFICATE'``CC>R & CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY 3/29/2015 ' 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 4025 St. Cloud Dr. Suite 100 Loveland CO 80538 CONTACT Karole Peters NAME - .E,tI(970) 679-7355 F N (866)237. 2178 AJCPHONE C. EMAIL .karole-peters@leavitt.com INSURERS AFFORDING COVERAGE NAIC If INSURERA:Secura Insurance 22543 INSURED Custom Services Of Colorado, Inc. PO BOX 800 Mead CO 80542-0800 INSURERB:Plnnacol Assurance 41190 INSURER C: INSURER D: INSURER E INSURERF: COVERAGES CERTIFICATE NUMRFR-15-16 Renewal RFVIRIr1N NI IMRFR- 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 TYPE OF INSURANCE ADDL UBR POLICY NUMBER POLICY EFF MM/DDNYYY POLICY EXP MM/DDNYYY LIMITS GENERAL LIABILITY 0-TC-0003160361-5 3/29/2015 /29/2016 EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUROn-going Additional Insured Operations Only DAMAGE TO RENTED PREMISES Ea ccurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL B ADV INJURY $ Include X Blkt Addl Insured X Blkt Waiver of Sub GENERAL AGGREGATE $ 2,000,000 GML AGGREGATE LIMIT APPLIES PER: E PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY X PRO LOC $ AUTOMOBILE LIABILITY 0-A-003160362-5 /29/2015 /29/2016 EOaaccident)BINEDSINGLE LIMIT 11000,000 X BODILY INJURY (Per person) $ A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ Uninsured/Undennsured $ X 4 UMBRELLA LIAR X OCCUR 0-CU-003160363-5 /29/2015 3/29/2016 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 A EXCESS LIAS CLAIMS -MADE DIED X RETENTION$ 10,00 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below N I A 9025555 lanket Waiver of ubrogation 1/1/2015 1/1/2016 X WC STATU- OTH- �.LIAER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Ft. Collins is shown as additional insured as respects General Liability nut-UIZrc City of Ft. Collins 256 W. Mountain Avenue P. 0. BOX 580 Ft. Collins, CO 80522-0580 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 AUUKU Zb (ZUIU/U5) INS025 (201D05).01 Karole Peters/KAPETE 00<.O— ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD