HomeMy WebLinkAbout107473 CERTIFIED BUSINESS SERVICES INC - INSURANCE CERTIFICATEDATE (MM/DD/YYYY)
Aco CERTIFICATE OF LIABILITY INSURANCE
04/24/2017
PRODUCER THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION
Bill Mahaffy Insurance Agency, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
15281 E Smoky Hill Road HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Aurora CO 80015 720-886-0400 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
V-1
INSURED
Certified Business Services, Inc
6920 S Jordan Road, Ste K
Centennial, CO 80112
INSURERS AFFORDING COVERAGE
INSURER A: State Farm Fire and Casualty Corn
INSURERB:State Farm Mutual Auto Insurance
INSURER C
INSURER D.
INSURER E:
NAIC #
25143 25143
v 25178 25178
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
ADD'L
POLICY EFFECTIVE
POLICY EXPIRATION
LTR
INSRD
TYPE OF INSURANCE
POLICY NUMBER
DATE MM/DD/YY
DATE MM/DD/YY
LIMITS
A
y
GENERAL LIABILITY
96—J7-2303-0
04/02/2017
04/02/2018
EACH OCCURRENCE
$ 2,000,000
X COMMERCIAL GENERAL LIABILITY
DAMA E T RENTED
PREMISES "Ea occurrence
$ 300,000
CLAIMS MADE a OCCUR
MED EXP (Any oneperson)
$ 5,000
PERSONAL 8 ADV INJURY
$ 2, 000,000
GENERAL AGGREGATE
$ 4, 000, 000
GENL AGGREGATE LIMIT APPLIES PER
PRODUCTS - COMP/OP AGG
$ 4, 000,000
X PRO -
POLICY JECT LOC
B
Y
AUTOMOBILE
LIABILITY
150 6885—E05-06
010 8459—E02-06
05/05/2017
11/05/2017
COMBINED SINGLE LIMIT
(Ea accident)
$ 1, 000, 000
ANY AUTO
X
BODILY INJURY
(Per person)
$ 1, 000 000
ALL OWNED AUTOS
SCHEDULED AUTOS
X
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
X
PROPERTY DAMAGE
(Per accident)
$ 100, O00
GARAGE LIABILITY
AUTO ONLY- EA ACCIDENT
$
OTHER THAN EAACC
$
ANY AUTO
AUTO ONLY:
AGG
$
A
EXCESS/UMBRELLA LIABILITY
96—B3—Qll2-3
04/01/2017
04/01/2018
EACH OCCURRENCE
$ 1,000,000
X OCCUR 71CLAIMS MADE
AGGREGATE
$ 1, 000, 000
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
WC STATU- OTH-
TORYLIMIrS ER
E.L. EACH ACCIDENT
$
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. DISEASE - EA EMPLOYEE
$
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Nei y.Aw I"FY.w��
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Ft. Collins
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
P.O. BOX 580
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Ft. Collins, CO 80522
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED RE NIVE
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132849 03-13-2007 All rights reserved
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 (2001108)