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HomeMy WebLinkAboutR3 CONSULTING GROUP - INSURANCE CERTIFICATE (2)DATE ACORD/tCERTIFICATE OF LIABILITY INSURANCE 08/14/20081 t PRODUCER (916)488-4702 FAX (916)488-2336 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION DBA: McCI atchy Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE License #0724020 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 2410 Fair Oaks Blvd, Suite 140 Sacramento, CA 95825 INSURERS AFFORDING COVERAGE NAIC # INSURED R3 Consulting Group, Inc. INSURERA-. Hartford Insurance Co. 4811 Chippendale Dr., #708 INSURER Philadelphia Insurance Co. 0128 Sacramento, CA 95841-2554 INSURER C' INSURER D: INSURER E. Cn%/PDA!_FC 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. LT R DD' INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE fMM/DD1YYI POLICY EXPIRATION DATE IMMIDDryY) LIMITS GENERAL LIABILITY 57 SBA AT6312 SC 11/27/2007 11/27/2008, EACHOCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 5 300,000 CLAIMS MADE Fill OCCUR $ 10,000 MED EXP (Any one person) A PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG $ 4,000,000 X POLICY PECROT LOD J AUTOMOBILE LIABILITY ANY AUTO 57 SBA AT6312 SC 11/27/2007 11/27/2008 COMBINED SINGLE LIMIT (Ea awident) $ 2,000,000 BODILY INJURY (Per person) $ A ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS X BODILY INJURY (Per acjdent) $ X PROPERTY DAMAGE (Per ac ident) S GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC $ ANY AUTO IS AUTO ONLY AGO EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR El CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND 57 WBC NP9192 02 07/01/2008 07/01/2009 WC STATu- A EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE S 1,000,000 If yes, describe nde, SPECIALPROVISIONSbelm — E.L. DISEASE -POLICY LIMIT $ 1,000,000 B OTH�R ProTessional Liability PHSD218402 12/15/2007 12/15/2008 $2,000,000 Annual Aggregate $2,000,000 Each Claim $5,000 Deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCL IONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS E: Title: HHW Coordination Grant ij Additional Insureds: City of Fort Col��T�n's, the City, its officers, agents and employees Ten day notice of cancellation applies for non-payment of premium. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL City of Fort Collins 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ATTN: John Stephen BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY P.O. Box 580 OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE ACORD 25 (2001108) ©ACORD CORPORATION 1988 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) 57 SBA AT6312 SC THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSON OR ORGANIZATION City of Fort Collins ATTN: John Stephen P.O. Box 580 Fort Collins, CO 80522 Re: Project Title: HHW Coordination Grant (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement) Who is an insured (Section 11) is amended to include as an insured the person or organization shown in the Schedule as an insured but only with respect to liability arising out of your operations or premises owed by or rented to you. CG 20 26 11 85 Copyright, FIartford Fire Insurance Company