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HomeMy WebLinkAbout114340 CUSTOM SERVICES OF COLORADO - INSURANCE CERTIFICATE (2)AC" © DATE (MMID D/YYYY) V CERTIFICATE OF LIABILITY INSURANCE 3/28/2016 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 NAME: Karole Peters HONE 9-7FvEwing-Leavitt Insurance Agency A ( ) 355 (666)237-2178NEx 4025 St. Cloud Dr. E-MAILss:karole-peters@leavitt.com ADDRE Suite 100 INSURERS AFFORDING COVERAGE NAIC # Loveland CO 80538 INSURERA:Secura Insurance 22543 INSURED INSURER B :Pinnacol Assurance 41190 Custom Services of Colorado, Inc. INSURERC: PO BOX 800 INSURER D : Mead CO 80542-0800 I INSURER F : COVERAGES CERTIFICATE NUMBER-16-17 ALL 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 SUBR POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR Blkt Addl Insured 20-TC-0003160361 Additional Insured for On -going Operations Only 3/29/2016 3/29/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100 , 000 X MED EXP (Any one person) $ 5,000 X Blkt Waiver of Sub PERSONAL & ADV INJURY $ Included L AGGREGATE LIMIT APPLIES PER: POLICYECT LOC 70THER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2r000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOSAUTOS fx 20-A-003160362 3/29/2016 3/29/2017 COMBINED SINGLE LIMIT Ea accident $ 1, 000, 000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PerOPERTntDAMAGE $ A UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE 20-CU-003160363 3/29/2016 3/29/2017 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED I X I RETENTION $ 10,000 $ g WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 4025555 1/1/2016 1/1/2017 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Leased or Rented Equipment 20-TC-0003160361 3/29/2016 3/29/2017 Limit with $500 Deductible $25,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Ft. Collins is shown as additional insured as respects General Liability GANG LLLAI ION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ft. Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 256 W. Mountain Avenue ACCORDANCE WITH THE POLICY PROVISIONS. P. O. Box 580 Ft. Collins, CO 80522-0580 AUTHORIZED REPRESENTATIVE Karole Peters/KAPETE 00<_N_� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD NS025 (201401)