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HomeMy WebLinkAbout114340 CUSTOM SERVICES OF COLORADO INC - INSURANCE CERTIFICATE (9)ACOR& CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/22/2017 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 endorsements . PRODUCER CONTACT Karole Peters NAME Ewing -Leavitt Insurance Agency, Inc. PHONE (970) 679-7355 Nc No: (866)237-2178 4090 Clydesdale Parkway ADDRIesS:karole-peters@leavitt.com Suite 101 INSURERS AFFORDING COVERAGE NAIC>x INSURERA:Secura Insurance 22543 Loveland CO_ 80538 INSURED INSURERB:Pinnacol Assurance 41190 INSURERC: Custom. Services of Colorado, Inc. PO BOX 800 INSURERD: _INSURER E : Mead CO 80542-0800 INSURER F: COVERAGES CERTIFICATE NUMBER:18-19 WC 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 POLICY EXP - LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X❑ OCCUR 20-TC-0003160361-7 3/29/2017 3/29/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES PREMISES Ea occurrence $ X MED EXP (Any oneperson) $ 5,000 Blkt Additional Insured X Blkt Waiver of Subro PERSONAL BADVINJURY $ Included GEML RPOLICY AGGREGATE LIMIT APPLIES PER: a ECT LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY 20-A-003160362-7 3/29/2017 3/29/2018 COMBINED SINGLE LIMIT Ea accident $ 1 , 000 , 000 X BODILY INJURY (Per person) _ $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X NON -OWNED HIRED AUTOS AUTOS X PROPERTY DAMAGE Per accident $ A X UMBRELLA LAB X OCCUR 20-CU-003160363-7 3/29/2017 3/29/2018 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 EXCESS LIAB CLAIMS -MADE DE D X RETENTION 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/E ­ OFFICER/MEMBER EXCLUDED?XTIVE N / A 4025555 1/1/2018 1/1/2019 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 (Mandatory in If yes, describe under E.L. DISEASE - POLICY LIMIT I $ 1,000,000 DESCRIPTION OF OPERATIONS below A Leased/Rented Equipment 20-TC-0003160361-7 3/29/2017 3/29/2018 Limit with $500 deductible $25,000 DESCRIPTION OF OPERATIONS I LOCATIONS / 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 City of Ft. Collins 256 W. Mountain Avenue P. O. Box 580 Ft. 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 Karole Peters/KAPETE 00<4'� © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) INSMS nn�nna The ACORD name and logo are registered marks of ACORD