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HomeMy WebLinkAbout129729 EXODUS MOVING & STORAGE INC - INSURANCE CERTIFICATE (12)EXODUA OP ID: JY ACORO� 70T8129/2018 E (MMIDD/YYYY) `,,�� CERTIFICATE OF LIABILITY INSURANCE E(MMD/YY 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 CONTANAME: CT Kdren E. Siwek, CPA Brown & Brown Inc 4532 Boardwalk Dr, Suite 200 A/c"No. E:t:970-482-7747 FAX, No: 970-484-4165 Fort Collins, CO 80525 E-MAIL Karen E. Siwek, CPA ADDRESS: certificates@bbcolorado.com INSURED Exodus Moving and Storage Inc 120 NE Frontage Rd Unit D Fort Collins, CO 80524 INSURER A:Employers Mutual Casualty Co. 21415 INSURER B : GuideOne Prop & Cas Ins Co 13984 INSURER C : INSURER E: INSURER F : nnVFRAnFA CFRTIFICATF NI IMRFR• RFVISIAN NIIMRFR- 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. INSRPOLICY LTR TYPE OF INSURANCE ADDL UBR POLICY NUMBER EFF MM/DD YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE X I OCCUR 5D73266 09/01/2018 09/01/2019 AMA EST NTED PREMISESEa occurrence $ 500,00 MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 X POLICY PRO JECT ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,00 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) A X ANY AUTO SE73266 09/01/2018 09/01/2019 $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident NON -OWNED HIRED AUTOS AUTOS $ $ X Cargo UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 X AGGREGATE $ 5,000,00 B EXCESS LIAS CLAIMS -MADE 560000655-00 09/01/2018 09/01/2019 DIED I X I RETENTION $ 0 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N 5H73266 09/01/2018 09/01/2019 X I PER STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N / A E.L. DISEASE - EA EMPLOYEE $ 1,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1.000.00 A Cargo 5C73266 09/01/2018 09/01/2019 Cargo 500,00 A Warehouse 5C73266 09/01/2018 09/01/2019 Warehouse 1,750,00 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) r`FRTICIr`ATG LJnl nPO r`ANr`FI I ATIr1N CITYDIV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins Purchasing Division Attn: David Carrey AUTHORIZED REPRESENTATIVE Karen E. Siwek, CPA PO Box 580 Fort Collins CO 80522-0580 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD EXODUA PAGE 2 NOTEPAD INSURED'S NAME Exodus Moving and Storage Inc OP ID: JY Date 08/29/2018 When required by written contract the following forms may apply: eneral Liability: lanket Additional Insured - Form CG7578 lanket Waiver of Subrogation - Form CG7578 rimary and Non -Contributory - Form CG7578 utomobile Liability: lanket Additional Insured - Form CA7450 lanket Waiver of Subrogation - Form CA7450 rkers Compensation: anket Waiver of Subrogation - Form WC 000313 ss Liability: ow Form Inland Marine: Carrier: Employers Mutual Casualty Company Policy Number: 5C73266 Term: 09/01/2018 to 09/01/2019 for Truck Cargo $1,000,000 - Castatophe Limit $ 500,000 - Property in Vehicles rehouse Legal Liability $1,750,000 - Limit