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Home My WebLink About525323 XYBIX SYSTEMS INC - INSURANCE CERTIFICATE (2)ERGOSYS-02 MHOFF .44C4CWRO" �� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 09/28/2018 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 have ADDITIONAL INSURED provisions or 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 License # 0757776 HUB International Insurance Services (COL) 112517th Street, Suite 900 Denver, C080202 CONTACT Jennifer Wilke PHONE FAX (AIc, No, Ext): (720) 207-2367 (A/c, No):(866) 243-0727 nbMDRIEss:jennifer.wilke hubinternational.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: The Travelers Indemnity Company of America 25666 INSURED Ergoflex Systems, Inc. INSURER B : Travelers Casualty Insurance Company of Americ 19046 -INSURER C:The Phoenix Insurance Company 25623 dba Xybix Systems, Inc. CQCR LLC 8207 Southpark Cr INSURER D : Littleton, CO 80120 INSURER E : INSURER F : COVERAGES CFRTIFICATF NI IIUIRFR- n=%ff l1 ul. �rl. 1\LYIJI V11 1VUIYIOGII. To 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 TYPE OF INSURANCE ADDL SUER MD POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X GENERAL LIABILITY CLAIMS -MADE � OCCUR 680009A16819518 10/01/2018 10/01/2019 EACH OCCURRENCE $ 1,000,000 DAMAGET RENTEDFOEMISa nce $ 300,000 MED EXP (Anyoneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY D JE� LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY AUOTOS ONLY BA9A17253A18 10/01/2018 10/01/2019 EOMa'cINdEDtSINGLE LIMIT $ 1,000,000 X BODILY INJURY Perperson) $ BODILY INJURY Per accident $ PerOacEcidZIDAMAGE A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CUP9A18097118 10/01/2018 10/01/2019 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED I X I RETENTION $ 10,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECU I IVE YIN OFFICER/MIn H) EXCLUDED? I andatory In and If yes, describe under DESCRIPTION OF OPERATIONS below NIA UB5J67568818 10/01/2018 10/01/2019 X PER OTH- TAT ER E.L. EACH ACCIDENT 1 �000,000 $ E.L.- DISEASE= EA EMPLOYEE E.L. DISEASE -POLICY LIMIT $ 1,000,000 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Project: Dispatch Center Work Stations SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins, Transfort Bus Div. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. David Carey, CPPB City of Fort Collins Purchasing 6570 Portner Road Fort Collins, CO 80525 AUTHORIZED REPRESENTATIVE AL,UKU ZO (LU1b1U3) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD