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Home My WebLink AboutFMLASOURCE INC - INSURANCE CERTIFICATECERTIFICATE OF LIABILITY INSURANCE DATE (MMAIDIYYYY) 12/242014 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 PRODUCER Jan Wagner Agency 'O Box 9017 135 Crossways Park Drive Noodbury NY 11797 INSURED FMLASource, Inc. 455 N.Cityfront Plaza Dr,13thF Chicago IL 60611-5503 I PRONE mow,.800-735-1588 ,'., 888-290-0302 1 COVERAGES CERTIFICATE NUMBER: 1581821951 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 INSD MD POLICY NUMBER POUCY EW MMIDDIYYYYI POLICY EXP IMMIDDrYYYY)LIMITS A X COMMERCIALGENERALUABIUTY 02LX00899647710 11112015 1/12016 EACH OCCURRENCE $1,000,000 CLAIMS -MADE 7X OCCUR REMSES Ea600amenoe $1,000,000 MED EXP(Any one person) $5,000 PERSONAL B ADV INJURY $1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $3,000,000 RI- POLICY 0 PRO- ❑OC PRODUCTS-COMP/OPAGG $1.000,000 $ OTHER. A AUTOMOBILE lllIBlllTl' CA0661436565 /12015 1/12016 WIM IT Ea acadent $1,D00,000 BODI LY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per awdent) $ HIRED AUTOS X NON -OWNED AUTOS Ix PROPERTY DAMAGE$ PeramoleM 8 A X UMBRELLA UJU3 X OCCUR 02UD0040673271 /1/2015 1/12016 EACH OCCURRENCE $15,000,000 AGGREGATE $15,000,000 UL EXCESS LB CLAIMS -MADE DED X RETENTION $ 10,000 1 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN 71738445 11112015 1/1/2016 SPER F TATUTEERH ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT $1,000,000 OFFICERRAEMBER EXCLUDED? ❑NIA E.L. DISEASE - EA EMPLOYE $1.000,000 (Mandatory In NH) If yes. describe Under DESCRIPTION OF OPERATIONS below E. L. DISEASE -POLICY LIMIT 1 $1,000,000 A Professional 02LX0089964T710 1/12015 1/12016 Per Omurrenoe 1.000,000 Liability Aggregate 3.000,000 DESCRPTON OF OPERATKW S I LOCATIONS I VEHICLES (ACORD 101, Addltlonal Remarks SCNaduM, may M amcMd H more spas M npulnd) The City of Fort Collins, its officers, agents and employees are included as additional insureds as respects to General Liability when required by WRITTEN CONTRACT prior to a loss. City of Fort Collins 215 N. Mason Street 2nd Floor Fort Collins, CO 80522 MilCMgsl-ivl la`l9 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 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD