HomeMy WebLinkAboutRSM MCGLADREY INC - INSURANCE CERTIFICATEA� V CERTIFICATE OF LIABILITY INSURANCE
DATE/2011 IYYYY)
04/27/2011
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 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
Marsh USA Inc.
2405 Grand Boulevard, #900
CONTACT
NAME:
(A/C No Exth PHONE FAX
No):
E-MAIL
DDRE
Kansas City, MO 64108
Attn: KansasCity.Certrequest@marsh.com Fax: 212-948-0015
PRODUCER -
CUSTOMER to lf,
081623.001-Co 11-12 Daven 508251 22890 0
INSURERS AFFORDING COVERAGE
NAIC N
INSURED
INSURER A: ACE American Insurance Company -
22667
RSM McGladrey, Inc.
One H&R Block Wall
Kansas City, MO 64105
INSURER B National Union Fire Ins Co Pittsburgh PA
19445
INSURER C: Indemnity Ins Go Of North America
43575
INSURER D :'xis Insurance Company
37273
INSURER E :
-
INSURER F:
COVERAGES CERTIFICATE NUMBER: CHI-003508251-03 REVISION NUMBER: 2
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
ADDLTYPE
NSR
SUER
POLICY NUMBER
EFF
MWDD/YYYY
POLICY YY
MWDD/VYPOLICY
LIMITS
A
GENERAL LIABILITY
HDOG25528839
05/01/2011
05/01/2012
EACH OCCURRENCE
$ 2,000,000
X COMMERCIAL GENERAL LIABILITY.
CLAIMS -MADE M OCCUR
-
-
DAMAGE TO RENTED
PREMISES Ea occurrence
$ 1,000,IX)O
MED EXP (Any one person)
$ NIA
PERSONAL & ADV INJURY
$ 2,000,000
GENERAL AGGREGATE
$ 10,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 2,000,000
X POLICY PRO- LOCI
I
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
ISA H08634464
05/01/2011
05/01/2012
COMBINED SINGLE LIMIT
(Ea accident)
$ - 2
X
BODILY INJURY (Per person)
$
ALL OWNED AUTOS
BODILY INJURY (Per accident)
$
SCHEDULED AUTOS
HIRED AUTOS
PROPERTY DAMAGE
(Per accident)
$
$
NON -OWNED AUTOS
-
B
X
I UMBRELLA LIAR
X
OCCUR
BE 9974983
05/01/2011
05/01/2012
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 5,000,000
EXCESS LIAB
CLAIMS -MADE
DEDUCTIBLE
$
$
RETENTION $
A
WORKERS COMPENSATION
WLR C46479610 (CA, AZ 8 MA)
05/01/2011
05/01/2012
X WC STATUTs - orH-
EEL
C
C
AND EMPLOYERS' LIABILITYYIN
ECUTIVE a
OFFANY CERIMEMBEPROPRIETOR EXCLUDED?
NH) Excwoeoa
(Mandatory in NH)
(Mandatory
N / A
WLR C46479634 (ADS)
RWC C46479622 WI, ME 8 OR
i )
05/01/2011
05/01/2011
05/01/2012
05/01/2012
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYE
$ 1-000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT I
$ 1000 000
D
Property
MCB726493-11
05/01/2011
05/01/2012
Blanket Limit, All Risk $100,000,000
Replacement Cost
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Office: 201 W Harrison, Suite 300, Davenport IA 52801
City of Fort Collins, Colorado is named as Additional Insured if required to be so by written contract. Coverage shown is primary and noncontributory if required to be so by written contract. Waiver of Subrogation is granted
if required to be so by written contract.
CERTIFICATE HOLDER CANCELLATION
City of Fort Collins, Colorado
Attn: James B. O'Neill, Director of Purchasing and Risk Mgmt.
215 N. Mason Street, 2nd Floor
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
of Marsh USA Inc.
Keith A. Stiles
01988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD