HomeMy WebLinkAboutADDED VLAUE SERVICE LLC - INSURANCE CERTIFICATEACC)Ror CERTIFICATE OF LIABILITY INSURANCE
DATE(MMA)DfYYYY)
11/12/2019
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 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 COWest Ins DTC
NAME:
CO WEST INSURANCE GROUP
PHONE (.720)4S7-9457 FAX (303)688-8858
ac Not:
3929 E. Arapahoe Rd. #110A
E-MAIL
ADDRESS:
INSURE S AFFORDING COVERAGE
NAIC 11
INSURERA: Colony Insurance Company
Centennial CO 80122
INSURED
INSURERB:Pinnacol Assurance
41-190
INSURER C:
Added Value Service, LLC
7346 S. Alton Way Suite lO H
INSURERD:
INSURER E:
Centennial _ CO 80112
INSURER F:
COVERAGES CERTIFICATE NUMBER:19/20 MASTER REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCES LISTED BELOW HAVE BEEN ISSUED TO THE INSURED'NAMEDABOVE FOR THEPOLICY 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,
EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I
LTR
TYPE OF INSURANCE
R
POLICY NUMBER
MMIDDY/YYYY
EXP
MEFF MIDDY/YYYY
_ LIMITS
C
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OX OCCUR
_
101GLO160212-00
11/10/2019
11/10/2020
-
OCCURRENCE _
-1,00EACH
$. 0, 000
DAMAGET RENTED
PREMISES. Ea occurrence
S 100,000
MED EXP.(Any.one person) -
$. 5,000
-PERSONAL BADV.INJURY .
$. 1,000,000
GEN'LAGGREGATE LIMITAPPLIES PER:
X POLICY ❑ PRO- ❑ LOC
JECT
OTHER:
GENERAL AGGREGATE
$ 2,000,00o
- -
PRODUCTS--COMP/OP AGG
- - 2,000,000
$
$
AUTOMOBILE
LIABILITY
ANYAUTO
ALL OWNED SCHEDULED
AUTOS S
AUTO
NON -OWNED
HIRED AUTOS AUTOS
COMBINED SINGLE LIMIT --
Ea accident
$-
BODILY INJURY (Per person)
$
(acc) BODILY INJURY Per accident)
$
PROPERTY DAMAGE
Per acdtlem
$
$
UMBRELLA LIAB
EXCESS LIAR
OCCUR
CLAIMS -MADE
1
EACH OCCURRENCE
$
AGGREGATE
$
DED I I RETENTIONS
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY y I N
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑N/A
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
— - -
4206037
- '-
11/1/2019
11/1/2020
a PER OTH-
STAT TE ER
-
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EAEMPLOYEE
S 1 000,000
E.L. DISEASE -POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS'/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
City of Fort Collins
200 W Oak Street
Fort Collins, CO 80521
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE: DELIVEREDIN
ACCORDANCE WITH THE POLICY PROVISIONS.
Smith/ESS
reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
INS025 (201401)