HomeMy WebLinkAboutAFLAC INCORPORATED - INSURANCE CERTIFICATEACORD® CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDDIYYYY)
5/15/2014
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 ofthe 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.. ' .Y? rl
_ _ _ _ .•
.Smith Lanier CO �COIUmbi s
200 Brookstone Centre Parkway
SUlte 118 ....
CONTACT..:._.. -
NAME:
PHONE .. FAX' "-
k No:
EA1AIL -
ADDRESS:
INSURERS AFFORDING COVERAGE
NAIC N
Columbus GA 31904
INSURERA:Great Northern Insurance
�0303
INSURED 30AFLACINCOR
INSURER B:
INSURER C
Aflac Incorporated
Attn: Mr. Nelson Phillips
1932 Wynnton Road
INSURER D:
Columbus GA 31999
INSURER E
INSURER F :
COVERAGES CERTIFICATE NUMBER: 304038016 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
--rypE OF INSURANCE -
A
INSR
Me
POLICYNUMBER
POLICY EFF
IY MMIDDVYY
POLICY EXP
IY MMIDDYYY
— LIMITS
A
GENERAL LIABILITY
35960492
/16/2014
/16/2015
EACH OCCURRENCE
$1,000,000
X COMMERCIAL GENERAL LIABILITY
PREMISES fEa occurrence
$1,000,000
MED EXP Any one person
$10,000
CLAIMS -MADE I OCCUR
PERSONAL B ADV INJURY
$2.000,000
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE
LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$2,000,000
Gen ADS Cap
S401000,000 '
17 POLICY
k JEC . / LOC
a
- ' -
-
A
-
AUTOMOBILE
LIABILITY
.. ._.
73580109
/16/2014
/16/2015
Ea accident)
_
BODILY INJURY (Per person)
$—-
X
... .. _
ANY AUTO - i',J
..
"-'
ALLOWNED SCHEDULED :.
AUTOS AUTOS
BODILY INJURY (Per accident
)
$ '
PROPERTY DAMAGE
Peraccid rt -
$ '
-
NON -OWNED
HIRED AUTOS ' AUTOS -
-
S
B
X
UMBRELLA LIAR
OCCUR
79825301
/16/2014
511612015
EACH OCCURRENCE
$10,000,000
AGGREGATE
$10,000,000
EXCESS LIAB
CLAIMS -MADE
DEB I X RETENTION$ 10.000
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
1716058
/16/2014
/16/2015
X WC STATU- OTH-
ITS ER
E.L. EACH ACCIDENT
$500,000
ANY PROPRIETCR/PARTNER/EXECUTIVE
OFFICEMMEMBER EXCLUDED?
NIA
E.L. DISEASE - EA EMPLOYEE
$500.000
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONSbel.
EL DISEASE -POLICY LIMIT
$500.000
A
Property
Replacement Cost
5960492
-ii6/2014
/16/2015
Loss Limit $400,000,000
EDP Included
Deductible $25,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
'Aflac's independent insurance agents are not employees of Aflac and are not covered by this Certificate of Insurance"
City of Fort Collins
215 North Mason, 2nd Floor
Fort Collins CO 80524-0000
111L-Jel
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
n 1988-2010 ACORO CORPORATION All rinhts
ACORD 25 (2010105)
The ACORD name and logo are registered marks of ACORD