HomeMy WebLinkAbout310036 BLUE DOT SOLUTIONS INC - INSURANCE CERTIFICATE (14),acoRo CERTIFICATE OF LIABILITY INSURANCE
DATE (NM/DD�YYYY)
08/15/2019
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 CONTACT
NAME:
David Carothers PHONE 888 3b0-7729 — FAX --
c/o Praxiom Risk Management, LLC E4AAlIL Ex11: t ) Aa rvot _
123 West Bloomingdale Avenue #300 ADDRESS:
Brandon, FL 33511 _ INBURER_(SZAFFOROMG COVERAGE NAICI
INSURER A: American Zurich Insurance Company 40142
INSURED INSURER B :
Nextep. Inc. and Nextep Business Solutions. Inc. All. Emp: Blue Dot Solutions Inc
1800 North Interstate Drive INSURER C : _
Norman. OK 73072 INSURER D :
INSURER E :
INSURER F:
COVERAGES CERTIFICATE NUMBER:19OK505941579 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.
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8
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AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETORIPARTNER/EXECUTIVE
A OFFICERMEMSEREXCLUDED9 NIA
I E.L. EACH ACCIDENT
WC56-11-380-06 08/01/2019 08/01/2020
$ 1.000.000
(Mandatory In NH)
E.L. DISEASE -EA EMPLOYEE,
s 1 000.000
II ppes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
Location Coverage Period: 08/01/2019 08/01/2020 Client# 1483-CO
DESCRIPTION OF OPERATIONS f LOCATIONS VEHICLES (ACORD 101. Additional Remarks Schedule. may be attached If more space Is required)
Blue Dot Solutions Inc
Coverage is provided for
1120 Lincoln St Ste 1507
only those co -employees
or, but not subcontractors Denver, CO 80203
to:
CERTIFICATE HOLDER CANCELLATION
CITY OF FORT COLLINS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
ATTN: JIM HUME, PURCHASING DEPARTMENT
THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
P. O. BOX 580
ACCORDANCE WITH THE POLICY PROVISIONS.
Ft. Collins. CO 80522
AUTHORIZED REPRESENTATIVE
tc� 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and loco are registered marks of ACORD 2' of 2 8397