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HomeMy WebLinkAboutCIGNA HEALTH AND LIFE INSURANCE COMPANY - INSURANCE CERTIFICATEACOR�0 CERTIFICATE OF LIABILITY INSURANCE DATE 04/30/2015 IYYYY) (MMID 2015 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 endorsement(s). PRODUCER Marsh USA Inc. 1717 Arch Street CONTACT NAME:FAX AJON No xt : __ ___ _ ___-__ (A/C No): Philadelphia, PA 19103-2797 Attn: Healthcare.AccountsCSS@marsh.com FAX: 212-948-1307 ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: National Union Fire Insurance Co. of Pittsburgh, PA 19445 100607-PRIM-CRIME-15-16 INSURED CIGNA HEALTH AND LIFE INSURANCE INSURERS : ---- COMPANY INSURER C : INSURER D : 900 COTTAGE GROVE ROAD BLOOMFIELD, CT 06002 INSURER E : INSURER F : CnVFRAGFS CERTIFICATE NUMBER: CLE-004121357-03 REVISION NUMBER:1 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 SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ _ _ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ MED EXP (Any one person) $ CLAIMS -MADE ED OCCUR PERSONAL & ADV INJURY $ GENERAL -AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ _ $ POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS PerOPERTntDAMAGE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION WCTA STU- OTH- IT RY LIMITS I ER AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y� -- $ E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYE $ _ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A E L DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below A CRIME/FIDELITY 012334190 04/30/2015 04/30/2016 LIMIT $5,000,000 DEDUCTIBLE $2,500,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) EVIDENCE OF COVERAGE GERTIFICAT E CITY OF FORT COLLINS 215 NORTH MASON STREET FORT COLLINS, CO 80524 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 of Marsh USA Inc. Manashi Mukherjee ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 100607 _ LOC #: Philadelphia A�CO%e[7® ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA Inc. CIGNA HEALTH AND LIFE INSURANCE COMPANY 900 COTTAGE GROVE ROAD POLICY NUMBER BLOOMFIELD, CT 06002 CARRIER NAIC CODE EFFECTIVE DATE: IVAL KtMAKl1J THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance "IF EVIDENCE OF COVERAGE IS NO LONGER REQUIRED, KINDLY RETURN THE CERTIFICATE MARKED "NO LONGER REQUIRED", AND WE WILL ADJUST OUR FILES ACCORDINGLY." "THIS CERTIFICATE SUPERSEDES ALL PREVIOUS FIDELITY I CRIME CERTIFICATES." ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD