HomeMy WebLinkAbout172842 XEROX BUSINESS SERVICES LLC DBA AFFILIATED - INSURANCE CERTIFICATEAC �®
CERTIFICATE OF LIABILITY INSURANCE
DATE(MMI1)
20
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
AOn Risk Services Northeast, Inc.
New York NY Office
COWACT
NAME:
FAX
INC �No. Eat): (H66) 283-7122 Ax; No.): 800-363-0105
EMAIL
ADDRESS:
199 water Street
New York NY 10038-3551 USA
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURED
INSURER A: Chartis Specialty Insurance Company
26883
Xerox Business Services, LLC. dba
Affiliated Computer Services
INSURER B:
INSURER C:
2828 N. Haskell Ave.
Dallas TX 75204 USA
INSUD RER :
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 570050074909 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
LTR
TYPE OF INSURANCE
INSR
VIVID
POLICY NUMBER
MMI00
MM'DO
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
COMMERCIAL GENERAL LIABILITY
A
PREMISES(Ea pccunence
CLAIMS -MADE ❑ OCCUR
MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
GEN'L AGGREGATE LIMIT APPLIES
PER:
PRODUCTS - COMP/OP AGG
POLICY PRO-
LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea
BODILY INJURY (Per person)
ANY AUTO
BODILY INJURY (Per accident)
ALL OWNED SCHEDULED
AUTOS AUTOS
HIRED AUTOS NON -OWNED
AUTOS
(,ttDANNGE
or
Per actident
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
AGGREGATE
EXCESS LIAB
CLAIMS -MADE
DED
RETENTION
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY YIN
WC STATU-
TORY LIMITS
DTI+
ER
E.L. EACH ACCIDENT
ANY PROPRIETOR I PARTNER I EXECUTIVE
OFFICEWMEMBER EXCLUDED'
NIA
E.L. DISEASE -EA EMPLOYEE
(Mandatory, In NH)
1l yes, desrn6a under
DESCRIPTION OF OPERATIONS WWI
E.L. DISEASE -POLICY LIMIT
A
E&O-PL-Primary
025827848
05/26/2013
05/26/2014
Aggregate
410, 000, 000
SIR applies per policy terns
& condi
ions
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AUach ACORD 101, Addhbnal Remarks Schedule, If more space is required)
Name in 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 N ACCORDANCE WITH THE
POLICY PROVISIONS.
City Of Fort Collins AUTHORIZED REPRESENTATIVE
215 N. Mason Street, 2nd Floor
Fort Collins, CO 80524 USA
01988.2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD