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HomeMy WebLinkAbout525323 XYBIX SYSTEMS INC - INSURANCE CERTIFICATE (4)riinnfff• r,R1QRR YVRISVCT9 ACORD-,, CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/M/DDI YYYY) 9/28 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 Kimberly Stephens NAME HUB International Ins Svcs Inc PHONE 720-207-2376 FAX 866-243-0727 A/C No, Ext : A/C, No 1125 17th Street, Suite 900 E-MAIL ADDRESS: kimberly step hensl:.//��hubinternational.com Denver, CO 80202 INSURER(S) AFFORDING COVERAGE NAIC # 888 795-0300 INSURER A: Travelers Indemnity Co America 25666 INSURED INSURER B : Travelers Indemnity Co 25658 Ergoflex Systems Inc. INSURER CPhoenix Insurance Co 25623 dba Xybix Systems Inc. TlCasualty Insurance Co INSURER D : Travelers Y 19046 8207 Southpark Cr Littleton, CO 80120 INSURER E CA License #0757776 INSURER FHUB COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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 INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDDIYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR 6809A1681951542 10/01/2015 10/01/2016 EACH OCCURRENCE $1,000,000 PREMISES (ERENTED r nce)$ 30O 000 MED EXP (Any one person) $10 000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC JECT PRODUCTS - COMP/OP AGG $2,000,000 $ D AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED X HIRED AUTOS X AUTOS BA9A17253A15 10/01/2015 10/01/201 de (CEO, ENE 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERT Per accidYent DAMAGE $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CUP9A1809711542 10/01/2015 10/01/2016 EACH OCCURRENCE s5,000,000 AGGREGATE s5,000,000 DED X RETENTION $1 O OOO $ _ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A INUSSD77490415 10/01!2015 111/01/201 X WC STATU- OTH- DIY T E.L. EACH ACCIDENT $1 000 000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Project: Dispatch Center Work Stations CERTIFICA City of Fort Collins Transfort Bus Div. David Carey, CPPB City of Fort Collins Purchasing 6570 Portner Rd Fort Collins, CO 80525 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 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD 1tC'1FRF9r,7/M4RA5Q4d PVf11