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HomeMy WebLinkAboutCIGNA CORPORATION - INSURANCE CERTIFICATEA4=0R0 CERTIFICATE OF LIABILITY INSURANCE DATE(M01/2014 Y) ono1no14 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(les) 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 endomement(s). PRODUCER AOn Risk Services Central, Inc. Philadelphia PA office CONTACT NAME: PHONE (866) 283-7122 FAX (800) 363-0105 INC. No. EXq: Arc. No.: E-MAIL ADDRESS: One Liberty Place 1650 Market Street Suite 1000 Philadelphia PA 19103 USA INSURER(S) AFFORDING COVERAGE NAICIf INSURED INSURER A: ACE American Insurance Company 22667 Cigna Corporation Et Al Bl0 could o mfieldgCT 061e Gr06152 USA Road Bloomfield INSURER B: Indemnity Insurance Co of North America 43575 INSURER C: ACE Fire Uncle rw eriters Insurance Co. 20702 NSURER D: NSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570054426032 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 INSD WVD POLICY NUMBER MMIDDIYYYY M. "DDffYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY HDOG EACH OCCURRENCE $1, 000, 000 CI -AIMS -MADE OCCUR PREMISES Ea occumar. $1, 000, 000 VIED UP (Any ore person) $5,000 PERSONAL &ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 X POLICY ❑JET F-1LOC PRODUCTS - COMP/OP AGG $1,000,006 OTHER: A AUTOMOBILE LIABILITY ISA H08820958 07/01/201407/01/2015 COMBINED SINGLE LIMIT Ea acadeM 1, 000, 000 $ BODILY INIURY(Per person) X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS BODILY INJURY (Par accadem) PROPERTY DAMAGE Par accident Med'cal Payments W S 5, 000 UMBRELLA LMB OCCUR EACH OCCURRENCE EXCESS LIAB CIAIMSAIADE AGGREGATE DED 0.ETENTION B A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR I PARTNER I UECUTIVE OFFICEWMEMBER EXCLUDED? N/A WLRC47888724 (ADS) WLRC47BB8712 07 O1 2014 07/Ol/2014 07/01 2015 07/Dl/201$ X PER OTH- STATUTE ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE-U EMPLOYEE $1,000,000 (Mandatory in NH) (CA, MA) If yea, desenbe Under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000, DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 101, AdEdional Remerka Schedule, may be attached a mom space is required) Named Insured includes: Cigna Health and Life Insurance Company, 900 Cottage Grove Road, Bloomfield, CT 06002. RE: Proof of Insurance for RFP No. 7649. City of Fort Collins, its officers, agents and employees are included as Additional Insured in accordance with the policy provisions of the General Liability and Automobile Liability policies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED W ACCORDANCE WITH THE POLICY PROVISIONS, City Of Fort Collins AUTRORRED REPRESENTATIVE 215 N. Mason Street, 2nd Floor Fort Collins CO 80522 USA `ro c m a A. 22 0 S ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 10042023 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk Services Central, Inc. NAMED INSURED Cigna Corporation Et Al POLICY NUMBER See Certificate Number: 570054426032 CARRIER See Certificate Number: 570054426032 NAIC CODE EFFECTIVE DATE, ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR LTR TYPE OF INSURANCE ADDL INSD SUER WVD POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/Y19'V POLICY EXPIRATION DATE MM/DD/YYVY LIMITS WORKERS COMPENSATION C N/A SCFC47888736 (WI) 07/01/2014 07/01/2015 A N/A WLRC47888608 (Wv) 07/01/2014 07/01/2015 ACORD 101 (2008101) ® 2008 ACORD CORPORATION. All rights mowed. The ACORD name and logo are registered marks of ACORD