HomeMy WebLinkAboutC.C. SERVICES INC - INSURANCE CERTIFICATEA� o" CERTIFICATE OF LIABILITY INSURANCE 5/1/2016
DATE(MM/DD/YYYY)
4/27/2015
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 LOCKTON COMPANIES
525 W. Monroe, Suite 600
CHICAGO IL 60661
(312) 669-6900
CONTACT
NA
:FAX
A/C No Ezt : A/C No):
E-MAIL
ADDRESS
INSURERIS) AFFORDING COV RA E
NAIC If
INSURER A: Travelers Property Casualty Co of America
25674
INSURED C.C. SERVICES, INC.
1063585 1701 TOWANDA AVENUE
BLOOMINGTON IL 61701
INSURER 8:
INSURER C:
INSURER
E
INSURER F
Cr1VFRof;FS ('CCRROI CERTIFICATE NIIMRFR 13,146960 REVISION NIIMRFR: XXXXXXX
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
iNso
SUBR
yYVD
POLICY NUMBER
POLICY EFF
NI / p
POLICY EXP
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
Y
N
660 6B643019
5/1/2015
5/1/2016
EACH OCCURRENCE
1,000,000
DAMAGE TO RENTEDenc
PREMISE Ea ccurre
1,000,000
CLAIMS -MADE OCCUR
X
jlo,ts 1.iquorIJah_
MED EXP (Any oneperson)
10,000
Included
PERSONAL BADVINJURY
$ 1000000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 5,000,000
}( POLICY�JECT LOC
PRODUCTS - COMP/OP AGG
$ 5,000,000
$
OTHER
AUTOMOBILE
LIABILITY
ANY AUTO
NOT APPLICABLE
COEa 9BINEDISINGLE LIMIT
$XXXXXXX
BODILY INJURY (Per person)
$XXXXXXX
NED gUTOSULED
AUTOW
BODILY INJURY (Per accident
$XXXXXXX
PROPERTY
acccdentDAMAGE
$ XXXXXXX
HIRED AUTOS NON -OWNED
UMBRELLA LIAR
OCCUR
EACH OCCURRENCE
$ XXXXXXX
EXCESS LIAB
CLAIMS -MADE
NOT APPLICABLE
AGGREGATE
$ XXXXXXX
DED RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETORIR/EXECUTIVE El
EXCLUDED'
OFFICER/MEMBER E%CLUDED?
(Mandatory in NH)
NIA
NOT APPLICABLE.
PER OTH-
STATUTE
E.L. EACH ACCIDENT
$ XXXXXXX
EL DISEASE - EA EMPLOYEE
! v v
XXXXXXX
If yes. desambe under
DECCRIFTON OF OPERATIONS blow
IE.L.DISEASE -POLICY LIMIT
XXXXXXX
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: Tom Hegna Presentation, May 19, 2015 City of Fort Collins and Lincoln Center is included as additional insured as required by written contract with
respect to general lability per the terms and conditions of the policy.
GtK I IFIGA I t HULUtK L.ANI.tLLA I IUN
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
13446960 AUTHORIZED REPRESENTATIVE
City of Fort Collins
417 West Magnolia Street
Fort Collins CO 80521
ACORD 25 (2014/01) 19W-204 A ORD750POkkMN. All rights reserved
The ACORD name and logo are registered marks of ACORD