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HomeMy WebLinkAboutH & H DATA SERVICES INC - INSURANCE CERTIFICATE-� OP ID: TA ACORO 7TE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE /07/2015 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). CONTACT PRODUCER Phone: 970-223-1804 NAME: 1100FrontRange InsuranceHaxton Drive Suite 100 roup Fax: Viac No. Exs): _ FAX No): Fort Collins, CO 80525 E-MAIL ADDRESS: David A. Wooldridge LUTCFAAI PRODUCER in x�HHELE-1 r•ucrnuco INSURERS AFFORDING COVERAGE NAIC # INSURED H & H Data Services, InC. INSURER A: Secure Insurance Companies 22543 Joe Hehn INSURER B : Pinnacol Assurance 41190 1310 Webster Avenue Fort Collins, CO 80524 INSURERC: INSURER D : INSURER E : INSURER F : CAVFR Ar GC CERTIFICATE NIIMRFR• RFVISION NIIMRFR: 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 SUB POLICY NUMBER ICY EFF DD/YYYY MMI• POLICY EXP MM DDIYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1XI OCCUR X TC3140442 07/01/2015 07/01/2016 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED PREMISES Ea occurrence $ 100 00 MED EXP (Any one person) $ 5,00 PERSONAL& ADV INJURY $ 1,000,00 X EPL: $100,000 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNEDAUTOS X A3140443 07/01/2015 07/01/2016 COMBINED SINGLE LIMIT $ 1,000,000 X BODILY INJURY (Per person) BODILY INJURY $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CU3140444 07/01/2015 07/01/2016 EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 DEDUCTIBLE RETENTION $ 10,000 $ X $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 4172851 05/01/2015 05/01/2016 X I WC STATU- OTH- T Y LIMIT ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEE $ 500,00 E.L. DISEASE - POLICY LIMIT $ 500 00 A A Business Pers Prop Floater TC3140442 TC3140442 07/01/2015 07/01/2015 07/01/2016 07/01/2016 BPP 271,40 Floater 129,63 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Fort Collins, its officers, agents and employed shall be named as additional insured's with respects to the General Liability and Auto Policies for any claims arising out of work performed under this agreement lha►4112L9G\IMiLai 4 fail FORTC-1 City of Fort Collins P.O. Box 580 Fort Collins, CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD No Text