HomeMy WebLinkAboutR3 CONSULTING GROUP - INSURANCE CERTIFICATE (3)ACORP. CERTIFICATE OF LIABILITY INSURANCE
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1 06/29/2009)
PRODUCER (916)488-4702 FAX (916)488-2336
DBA: McCI atchy Insurance Agency
License #0724020
2410 Fair Oaks Blvd, Suite 140
Sacramento, CA 95825
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC #
INSURED R3 Consulting Group, Inc.
4811 Chippendale Dr., #708
Sacramento, CA 95841-2554
'
INSURER A: Hartford Insurance Co.
INSURERS:
INSURER C
- - -- - -
INSURER D:
INSURER E _. .. ....... _ .._ _.
_ . .
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
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TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION DATE IMMIDDIYYI
LIMITS
GENERAL LIABILITY
MERCIAL GENERAL LIABILITY
CLAIMS MADE ❑ OCCUR
71M
4—
EACH OCCURRENCE
$
DAMAGE TO RENTED
$
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE -
$
GENT AGGREGATE LIMIT APPLIES PER:
POLICY PRO LOC
JECT
PRODUCTS - COMP/OP AGG
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS -
- �
_...
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
.,
$
PROPERTY DAMAGE
(Per accident)
GARAGE LIABILITY
ANY AUTO
...
AUTO ONLY - EA ACCIDENT
$.,
OTHER THAN EA ACC
AUTO ONLY:-- - AGG
$
$.. - - -- •-- - -
EXCESS/UMBRELLA LIABILITY
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
EACH OCCURRENCE
$
AGGREGATE
$
$
$
A
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
57 WBC NP9192 04
07/01/2009
07/01/2010
--
X I WC sTATU_ OTH-
TORY LIMITS FIR
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Consulting Services - Trash Service Study
Ten days 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 : Ann Turnqui st BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
215 North Mason St. 2nd . Fl r OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
Fort Collins, CO 80524 AUTHORIZED REPRESENTATIVE / . .
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nr AnnRn rnRPnPATInN IQRR
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 (2001/08)