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HomeMy WebLinkAbout172842 XEROX BUSINESS SERVICES DBA AFFILIATED COMP - INSURANCE CERTIFICATE� 1 ® " o CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDr/YYY) 66292D,P 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 AOD R15k services Northeast, Inc. New York NY Office CONTACT NAME:PHON (866) 283-]122 FA% (847) 953-5390 WC. N. Ea): ac. N.J: EMAIL ADDRESS: 199 Water street New York NY 10038-3551 USA INSURER(S) AFFORDING COVERAGE NAIC4 ri. U `lam INSURED INSURER A: Charti5 Specialty Insurance Company 26883 XeroX Business Services, LLC. dba Affiliated Computer services INSURER B: INSURER C: 2828 N. Haskell AVE. Dallas TX 75204 USA INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER' h/UU4h379823 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE INSR MD POLICY NUMBER MMIDO MMID LIMITS GENERAL LIABILITY EACH OCCURRENCE PREMISES Ea occVrrence COMMERCIAL GENERAL LNBLRV CLAIMS -MADE ❑ OCCUR MED EXP (My one person) PERSONAL S ADV INJURY GENERALAGGREGATE AGGREGLIMIT APPLIES ATE PER: PRODUCTS-COMPIOP AGO 71 PRO POLICY LOL AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 8 BODILY INJURY( Per person) ANY AUTO ALL OWNED SCHEDULED BODILY INJURY (Per acrident) AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident) UMBRELLA LWB OCCUR EACH OCCURRENCE EXCESS LIAB H CLAIMS -MADE AGGREGATE DED RETENTION WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS'LIABILRY YIN TORY LIMITS ER E.L. EACH ACCIDENT ANY PROPRIETOR I PARTNER I EXECUTIVE OFFICEWMEMUER EXCLUDED' ❑ NIA E.L. DISEASE£A EMPLOYEE (Mandatory in me uy deari6e under DESCRIPTION OF OPERATIONS Iwbw E.L. DISEASE -POLICY LIMIT A E&O-PrOfLidbPri 019326533 05/26/2012 05/26/2013 Aggregate 510,000,000 SIR applies per policy ter s & condi ions DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Anach ACORD 101, Addillonal Reuori Sci eduk, K more space is required) Name i0 Contract: Buck Consultants, LLC RE: RFP #P999 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins 215 N. Mason street, 2nd Floor AUTHOREED REPRESENTATIVE FOfi Collins, CO 80524 USA �� p IV. �/LrGk l91,9t ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD d