HomeMy WebLinkAbout579978 DATASPLICE LLC - INSURANCE CERTIFICATEACOR" CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDD/YYYY)
11/16/2017
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 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
Flood and Peterson
PO Box 578
Greeley CO 80632
CONTACT Javier Perez
NAME:
)V _No E (970)356-0123 A/C NO:(970)330-1867
E-MAIL JPerez@F1oodPeterson.com
ADDRESS:
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A:Philadel hia Indemnity Insurance
18058
INSURED
Datasplice, LLC; Optimization Resources, Inc.,
Optimization Resources, LLC
414 E Oak Street
Fort Collins CO 80524
INSURER B :Phoenix Insurance Company
25623
INSURERC:
INSURERD:
INSURERE:
INSURERF:
COVERAGES CERTIFICATE NUMBER-CL17111620578 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
MM/DDIYYYY
POLICY EXP
MM/DD/YYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 2,000,000
A
CLAIMS -MADE ❑X OCCUR
TEO
DREM O R NEaoccurcance
PREMISES
$ 300,000
MED EXP (Any one person)
$ 5,000
PHPK1579213
11/19/2017
11/19/2018
PERSONAL & ADV INJURY
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 4,000,000
X POLICY PRO ❑ LOC
JECT
PRODUCTS - COMP/OPAGG
$ 4,000,000
$
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
X
BODILY INJURY (Per person)
$
A
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
PHPK1579213
11/19/2017
11/19/2018
BODILY INJURY (Per accident)
$
X
PROPERTY DAMAGE
Per accident
$
NON -OWNED
HIRED AUTOS X AUTOS
Uninsured/Underinsured
$ 1 , 000 , 000
X
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 5,000,000
A
EXCESS LIAB
CLAIMS -MADE
DED I X 1 RETENTIONS 5,000
$
PMM564068
11/19/2017
11/19/2018
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
X STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$ 1,000,000
B
OFFICER:'MEMBER EXCLUDED? ❑
(Mandatory in NH)
N / A
UB-6J989189-17-42
11/19/2017
11/19/2018
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
If yes describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
A
Errors& Omissions Liability
PEPK1579219
11/19/2017
11/19/2018
Occurrence $ 5,000,000
$ 5,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City
of Fort Collins
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Attn :
Purchasing Dept.
ACCORDANCE WITH THE POLICY PROVISIONS.
P.O.
Box 580
AUTHORIZED REPRESENTATIVE
Fort Collins, CO 80522
r
Javier Perez/JPEREZ
ACORD 25 (2014/01)
INS025onwii
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