HomeMy WebLinkAbout310036 BLUE DOT SOLUTIONS INC - INSURANCE CERTIFICATE (17)ACORhP CERTIFICATE OF LIABILITY INSURANCE
lllhk.�
DATE(MM/DD/YYYY)
07/16/2018
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
E- a Lo, Wit):_ ( ) 350 7729 (ac, 0:
-ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
Brandon, FL 33511
INSURER A: American Zurich Insurance Company
40142
INSURED
Nextep, Inc. and Nextep Business Solutions, Inc. Alt. 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:180K505941579 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
OF INSURANCE
L
ADDTYPE
U
POLICY NUMBER
MM/ D Y139 POLICY YYY
MM DD YYYY
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$
CLAIMS -MADE C OCCUR
PREMISEce
$
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$
POLICY,7 PRO-❑ LOC
JECT
PRODUCTS - COMP/OP AGG
$
$
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY (Per person)
$
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
UMBRELLA LIAB
EACH OCCURRENCE
$
HOCCUR
AGGREGATE
$
EXCESS LIAR
CLAIMS -MADE
DED RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N
OFFICER/MEMBEREXCLUDED?
(Mandatory in NH)
N/A
WC 56-11-380-05
08/01/2018
08/01/2019
X STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYE
$ 1,000,000
If as, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000 000
Location Coverage Period: 08/01/2018
08/01/2019
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:
UhK I IFI(;A I t HULUtH I,AN%,tLLA I IVIV
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
ACORD 25 (2016/03)
(c) 1988-2015
The ACORD name and l000 are registered marks of ACORD
TION- All riahts reserved