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HomeMy WebLinkAbout549111 COMPSYCH CORPORATION - INSURANCE CERTIFICATEAC40Rha CERTIFICATE OF LIABILITY INSURANCE 11 DATE(MMIDDIYYYY) 1 12/24/2014 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 Van Wagner Agency PO Box 9017 135 Crossways Park Drive NAMECONTACT : PNONE Ent'800-735-1588 AIC FAX .888-290-0302 E41AIL . request@sterlingrisk.com INSURI AFFORDING COVERAGE NAICO Woodbury NY 11797 INSURERA:Granite State Insurance Company 23809 INSURED INSURERS:Chubb Indemnity Insurance Company 12777 INSURERC: Compsych Corporation 455 N.Cityfront Plaza Dr,13thF Chicago I L 60611-5503 INSURER D INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 560285312 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 INSURANCEADDL INSD SUER WVD PODCY NUMBER POLICY EFF MMIDD/YYYY POLICY ExP MM/DD/YYYY UMrTS A X COMMERCULGENERALLUBIUTY 02LX00899647710 /112015 1/1/2016 EACH OCCURRENCE S1,000,000 CLAIMS MADE I X I OCCUR PREMISE$ Ea6 rrenoe $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 POLICY 0 jE T LOC PRODUCTS - COMP/OP AGO $1,000,0D0 $ OTHER I A AUTOMOBILE LIABIUTY CA0661436565 /l2015 1/1/2016 MUINEU (Ea eamdert) $1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED AUTOSULEO BODILY INJURY (Per accident) $ HIRED AUTOS X NON-0NMED AUTOS X RTYDAMA E Per accident S S A X UMBRELLA MB X OCCUR 02UD0040673271 /l2015 1/l2016 EACH OCCURRENCE $15,000,000 AGGREGATE $15,000,000 ExESSLIAB CIAIMS-MADE OECD X RETENTION$ 10,000 1 1 $ 1 B WORKERS COMPENSATION EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE 71738445 1/1/2015 1/1/2016 X STATUTE STATUTE ER E.L. EACH ACCIDENT $1.000.000 OFFICER?AMBER EXCLUDED? NIA E.L. DISEASE - EA EMPLOYE $1,000.000 (Mandatory In NH) If yes, des be under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT 1 $1,000,000 A Professional Liability 02LX00899647710 /12015 1/12016 Per Oceurence 1,000.000 Aggregate 3,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Addmalal Ramon; SLhwim, may be aeacbed If more space Is required) The City of Fort Collins, its officers, agents and employees are included as additional insureds as respects to General Liability when required by WRITTEN CONTRACT prior to a loss. laf aC\SI]LW-111 a$PJYJa: afticDl aN \c\$Pli Ala\arc City of Fort Collins 215 N. Mason Street 2nd Floor Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD