HomeMy WebLinkAbout310036 BLUE DOT SOLUTIONS INC - INSURANCE CERTIFICATE (19)ACC�RO® CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDNYYY)
07/27/2017
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 have ADDITIONAL INSURED provisions or 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
David Carothers
c/o Praxiom Risk Management, LLC
123 West Bloomingdale Avenue #300
CONTACT
NAME:
PHONE FAX
EA/C. No, Ext): (888) 350-7729 AIc No :
ADDRESS:_
------
INSURER(S) AFFORDING COVERAGE
NAIC #
Brandon, FL 33511
INSURER A: American Zurich Insurance Company
40142
INSURED
Nextep, Inc. and Nextep Business Solutions, Inc. Aft. Emp: Blue Dot Solutions Inc
1800 North Interstate Drive
INSURER B :
INSURER C :
INSURER D:
Norman, OK 73072
INSURER E:
INSURER F :
COVERAGES CERTIFICATE NUMBER: 170K505941.579 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 9 POLICY EFF POLICY EXP
L TYPE OF INSURANCE POLICY NUMBER MM/DD/YYY D/YYY LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$
_11CLAIMS-MADE
OCCUR
PREMISES Ea occurrence
$
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GEN'L
AGGREGATE LIMIT APPLIES PER:
POLICY JET LOC
GENERAL AGGREGATE
$
PRODUCTS - COMP/OP AGG
$
�
E
OTHER:
AUTOMOBILE
LIABILITY
COMRINED SINGLE LIMIT
Ea accident)
E
_
BODILY INJURY (Per person)
$
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
E
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
Per accident
$
$
I
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DED RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUDED7 a
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
WC 56-11-380-04
08/01/2017
08/01/2018
X OTH-
STATUTEI ER
E.L. EACH ACCIDENT
00
$ 1,0,000
E.L. DISEASE - EA EMPLOYE
$ 11000,000
E.L. DISEASE - POLICY LIMIT I
$ 1,000,000
Location Coverage Period:
08/01/2017
08/01/2018
Client# 1483-1
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
Coverage is provided for Blue Dot Solutions Inc
only those co -employees 1120 Lincoln St Ste 1507
of, but not subcontractors Denver, CO 80203
to:
1_LK I Ir rim I L MULUtK L ANL;LLLA I IUN
CITY OF FORT COLLINS
ATTN: JIM HUME, PURCHASING DEPARTMENT
P. 0. BOX 580
Ft. Collins, CO 80522
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
d�4,
0 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and loco are registered marks of ACORD