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Client#: 1926886 1501TSASOL
DATE (MM/DD/YYYY)
ACORD,�. CERTIFICATE OF LIABILITY INSURANCE aroai2oz3
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATNELY 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 any rights to the certificate holder in lieu of such endorsement(s).
PRODUCER ��,. NAMEACT Emily Booth
McGriff Insurance Services Pr+or,E � - - --- - - - -
(�ac, No, extL � 0 279-8550 ;�a , No •�, 610 279-8543
150 South Wamer Rd, Suite 460 , E-MAII ebooth mc riff.com
Q --- -- - -- -- - ____ _
, ADORESS -- -- �-- g _ _ _ _
ing f russia� A �9 O6'ZV3 INSURER(S�AFFORDINGCOVERAGE NAICB
610 279-8550 i� _ _ - - -- ----- --- -
-
iNsuReR a: Great American EB�S Insurance Company ,37532
---- ----- --- - -- — -- - +._
INSURED
- ------
iNsuReR e: Chubb National Insurance Company 10052
ITSA Solutions LLC ------_ __..-- -------------------- �--..__ _ _
450 Raritan Center Parkway, Suite F iNsurtert c:�ch Specialty Insurance Company �21199
�--- -
I INSURER D : �—
Edison, New Jersey 08837 - -- - - --- - - - --- - —
� INSURER E :
' INSURER F : �
COVERAGES CERTIFICATE NUMBER: 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 CONTR,4CT OR OTHER DOCUMENT WITH RESPECT 10 WH�CH TH�S
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 ADDL SUBR� ( POLICY EF� '�i � POLICY EXP
L7R TYPE OF INSURANCE INSR NND '�� POLICY NUMBER MMIDD/YYY � MMIDD/YYY � LIMITS
--� - -,---__. ._ ------_._._.-_---_ _..._�_ . - ---.. __---�_ . _.. --___.__-
___. __ S. _ - - - - - - -------- ---.___.... .----- -----. _. . .------
A X� COMMERCIAL GENERAL LIABILITY �� PL49S9'I �O6 4/04/2023 j O4IO4IZOZ�iI EACH OCCURRENCE I S'I,OOO�O __
� DAMA� E TO RENTED
! CLAIMSMADE ',_� OCCUR �, ' i PREMISES.(Ea occurrence� _ � S SOO�OOO __ _ __ _
XI BI/PD Ded:2,500 ! i ; -
i I Ij �MED EXP (Any one person) i 820,��0 _ ___
� � IPERSONAL&AOVINJURY 1S��OOO�OOO
--' -- � -----
�, PE a I i PER: i � i GENER4L AGGREGATE _ __��fS2,OOO,OOO
GEN'L AGGREGATE LIMIT APPIIE
i POLICY I I _�.. LOC I � PRODUCTS-COMP/OPAGG�SZ�OOO�OOO _._
� ---
� OTHER. � �
- -- ---------------- --�-----
--- ------------------- -----�---- ------------
- — � ------------ - ---_._.._ __
AUTOMOBILE LIABILITY I I I COMBINED SINGLE LIMIT �
ANY AUTO I
� {i OWNED � � SCHEDULED �
__i AUTOS ONLY I� AU70S
'� � HIRED i, NON-OWNED
;`,I�, AUTOS ONLY ��� AUTOS ONLY
i I
.__._;.._ -��-----
--- - - - - ------_�-
A j I UMBRELLA LIAB �I i �
_ ` ��DED _I _ '_RETENTIO � �CUR !
�(� EXCESS LIAB I X i CLAIMSMADE j
� - - --- i
B ! WORKERS COMPENSATION —�-
i AND EMPLOYERS' LIABILITY Y/ N I
I ANY PROPRIETOR/PARTNERiEXECUTIVE �
i OFFICER/MEMBER EXCLUDED? ��I N/ A
i, (Mandatory In NH) I
��� If yes, describe under
�� DESGRIPTION OF OPERATIONS below ____ _ I_
C '�Professional �
i
(Incl.Cyber Liab) ',
--- --------.-.___-- ----._
XS225978604
71801349
C4LPL100308
5I2023 I 02/1
BODILY INJURY (Per person) S
BODILY INJURY (Per accident) S
PROPERTYDAMAGE 5
IPer acddent)
S
AGGREGATE
�s�00_ _.
! X ;PER j �OTH-
i $TAT_USE — -�--1�� - -
! E.L EACH ACCIDENT $SO_O�OI
I E.l. DISEASE - EA EMPLOYEE SSOO.OI
�E L. DISEASE - POLICY LIMIT
24'� AGG: $2M --
, DED: $5,000
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101 , Addltlonal Remarks Schedule, maY be attached if more space Is requlred)
The City of Fort Collins Purchasing Division, its officers, agents and empfoyees are recognized as
additional insured with regards to general liability if required by written contract and are subject to the
terms and conditions of the policy.
City of Fort Collins Purchasing
Division
PO Box 580
Fort 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
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