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Home My WebLink AboutAPPLICATION SOFTWARE INC - INSURANCE CERTIFICATE (2)ACORO CERTIFICATE OF LIABILITY INSURANCE DATE (MWDD/YYYY) 01/23/2014 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 endorsements . PRODUCER CONTACT THE INSURANCE GROUP INC NAME PHONE FAX 200 EAST SOUTHAMPTON DRIVE AIC. No, Eat: AIC, No): E-MAIL ADDRESS'. COLUMBIA MO 65203 2545C INSURER(S) AFFORDING COVERAGE NAIL # INSURER TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA INSURED INSURER B'. APPLICATION SOFTWARE INC C/O JOHN RIDDICK INSURER C. INSURERD: PO BOX 6044 INSURERS COLUMBIA MO 65205 INSURER F. COVERAGES CERTIFICATE NUMBER: 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MMIDDIVYYV POLICY EXP MM/DD/VYVV LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any oneperson) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES 17 POLICY PROJECT PER. LDC PRODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY g HED ANY AUTO AUTOSULED ALL OWNED NON -OWNED AUTOS AUTOS HIRED AUTOS COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY Per person)8 BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident $ S UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE 5 DED RETENTION S $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? Y/N (Mandatory in NH) N If yes, describe under OESCRIPTION OF OPERATIONS below NIA (6JUB-9981 M73-6- 1 3) 1 O- 1 1 - 13 10- 1 1 - 14 X WC STATU- TORV LIMITS OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E. L.DISEASE - EA EMPLOYEE$ 1,000, 000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION CITY OF FORT COLLINS PURCHASING DIVISION PO BOX 580 FORT COLLINS CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREFO, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE /1 I i _Jr, J1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD TRAVELERS/ J 03919 -AM TRAVELERS - RMD P.O. BOX 3556 ORLANDO FL 32802-3556 CP 01 6640 G6640POS 14023 03919 P1 CITY OF FORT COLLINS PURCHASING DIVISION PO BOX 580 FORT COLLINS CO 80522 U490 : ij CERTIFICATE OF INSURANCE (On Reverse)