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HomeMy WebLinkAbout549111 COMPSYCH CORPORATION - INSURANCE CERTIFICATE (3)r ATE (MM/DD/YYYY) A� " CERTIFICATE OF LIABILITY INSURANCE 1 /2/2019 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 CONTACT NAME: Van Wagner Agency PHONE FAX Eac No): 888 290 0302135 Crossways Park Drive AIc No MAIL Box 9017AbRESS: re uest sterlin risk.com Woodbury NY 11797 INSURERS) AFFORUINGCOVERAGE NAIC9 INSURED Compsych Corporation 455 N.Cityfront Plaza Dr,13thF Chicago IL 60611-5503 INSURERA: Cincinnati Insurance INSURER B : INSURER C : rnVFRAnI=Q RFRTIPIRATF NI IMRFR• 9nnQRd407R RFVISICIN NI IMRFR- 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 OF INSURANCE ADDLTYPE INSD SUER POLICY NUMBER EFF MMIDPOLID/YYYY MCY / POLICY EXP /YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y ETDO517552 1/1/2019 1/l/2020 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS -MADE I X I OCCUR PREMISES Ea occurrence $ 1,000,000 X MED EXP (Any one person) $ 5,000 Abuse/Molestatio PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY ❑ ECT JT LOC EC PRODUCTS - COMP/OP AGG $1,000,000 Deductible $ 0 OTHER: A AUTOMOBILE LIABILITY Y ETD0517552 1/1/2019 1/1/2020 Ea .o.cll rdj SINGLE LIMIT $ 1 ,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ (PeOPEdclent) GE $ X HIRED AUTOS X AUTOS NON -OWNED AUTOS Deductible $ 0 A X UMBRELLA LIAR X OCCUR ETD0517552 1/1/2019 1/1/2020 EACH OCCURRENCE $ $10,000.000 AGGREGATE $$10,000,000 EXCESS LIAB CLAIMS -MADE DED I X I RETENTION $ in orin $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN Y EWC 0517556 1/1/2019 1/1/2020 X PER OTH- TAT TE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT _ $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below A ProfessionalLiability ETDO517552 1/1/2019 11112021 Per Occurence 1,000,000 Aggregate 3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Fort Collins, its officers, agents and employees are included as additional insureds as respect to General Liability as per endorsement form CG2026 and as respect to Auto Liability as per endorsement form 90812 (1-14) to the extent provided therein. lha:a112Lh_11111 =11111:Lai 4Ill 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. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD