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HomeMy WebLinkAbout551369 BACKBONE FIBER SYSTEMS LLC - INSURANCE CERTIFICATE (3)DocuSign Envelope ID: 2242F397-2B2E-4B1A-8A52-59FEEA02BE7D i - ACORO CERTIFICATE OF LIABILITY INSURANCE DATE (MhUDD7YYYY) 6/5/2015 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 1NSURER(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 Colorado BW Insurance Agency, Inc. 1075 W Horsetooth Rd, Ste 106 Fort Collins CO 80526 CONTACT Dennis Shafer NAME: PH°NE (970) 223-0924 FAX (970)267-2231 E-MAIL.dennis.shafer@bankofthewest.com DR INSURERS AFFORDING COVERAGE NAIC # INSURERA:United Fire & Casualty Co 13021 INSURED BACKBONE FIBER SYSTEMS LLC PO BOX 7312 LOVELAND CO 80537-0312 INSURERB:pinnacol Assurance 41190 INSURER C : INSURER D : INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER:CL1542487217 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. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MMiD !Y YY) POLICY EXP fMMIDDfYYyyI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES fEi occurrence) S 100,000 A CLAIMS -MADE NIOCCUR X 60423559 2/1/2014 2/1/2015 MEDEXP(Any one person) S 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X1 POLICY X PR,� LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea S 1,000,000 BODILY INJURY (Per person) $ `A ANY AUTO S ALL OWNED SCHEDULED X 60923554 2/1/2014 2/1/2015BODILYINJURY(Peraccident) AUTOS AUTOS PPROPERT S NON -OWNED Ix HIRED AUTOSX AUTOS tDAMAGE Uninsured motorist combined S 1 000 000 X UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE S AGGREGATE _ S A EXCESS LIAR DE. I X I RETENTIONS 10,OOC S 60423554 2/1/2014 2/1/2015 B WORKERS COMPENSATION X WWC STATU- X OTH- FR AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORtPARTNER)EXECUTIVE E.L. EACH ACCIDENT S 1,000,000 OFFICERIMEMBER EXCLUDED? [ (Mandatory In NH) N!A 4164180 /1/2015 /1/2016 E.L. DISEASE - EA EMPLOYEE S 1,000,000 If yes. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S 1,000,000 A Leased and Rented 60423554 2/1/2014 2/1/2015 $100,000 Equipment DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) The certificate holder is named as an Additional Insured as required by written contract with the Named Insured on the General Liability and Auto Liability coverage's. The insurance evidenced by this certificate will not reduce coverage or limits and will not be canceled except after 30 days written notice has been received by the City of Fort Collins. CANCELLATION creetz@fcgov.com SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. 215 North Mason Street, 2nd F1 P.O. BOX 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522-0580 ACORD 25 (2010105) ©1988-2010 A RD CO RATI N. All rights reserved. INS025 (2oloo5)01 The ACORD name and logo a e registered marks of ACORD