HomeMy WebLinkAbout541897 HYLAND SOFTWARE INC - INSURANCE CERTIFICATEACORO®
C" CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
12/18/2018
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 have ADDITIONAL INSURED provisions or 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 Karen Ormiston
NAME:
The James B. Oswald Company
A/CONNo Ext : (216) 367-8787 FAX No):(216) 241-4520
E-MAIL KOrmiston@oswaldcompanies.com
ADDRESS:
1100 Superior Avenue East
INSURER(S) AFFORDING COVERAGE
NAIC #
Suite 1500
INSURERA: Federal Insurance Company
20281
Cleveland OH 44114
INSURED
INSURER B: Great Northern Insurance Co.
20303
HSI Holdings I, Inc.
INSURER C : Pacific Indemnity Company
20346
INSURER D : Illinois National Ins Co
23817
Hyland Software, Inc
INSURER E :
28500 Clemens Road
INSURER F :
Westlake OH 44145
COVERAGES CERTIFICATE NUMBER: 18/19 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
R
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
Y
MMIDD /YYYY
MM/DD/YYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE X OCCUR
DAMAGE
PREMISES Ea occurrence
1000000
$ ,,
MED EXP (Any one person)
$ 10,000
A
35783325
12/31/2018
12/31/2019
PERSONAL& ADV INJURY
$ 1,000,000
GEN'LAGGREGATE LIMIT APPLIES PER.
GENERAL AGGREGATE
$ 2,000,000
X POLICY JEC LOC
PRODUCTS-COMP/OPAGG
$ 2,000,000
$
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
BODILY INJURY (Per person)
$
X ANY AUTO
B
OWNED SCHEDULED
AUTOS ONLY AUTOS
73522883
12/31/2018
12/31/2019
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
$
X
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 25,000,000
A
EXCESS LAB
CLAIMS -MADE
79882068
12/31/2018
12/31/2019
DED I X RETENTION $ None
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
N/A
71713993
12/31/2018
12/31/2019
X STATUTE EORH
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1-000,000
E.L. DISEASE - POLICY LIMIT
1 000, 000
$
If yes, describe under
DESCRIPTION OF OPERATIONS below
D
Errors & Omissions Liab
038244422
12/31/2018
12/31/2019
Retention :$500,000
Limit:10M
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
City of Fort Collins its officers agents and employees are included as Additional Insured if required by written contract for General Liability. 30 Day notice
of cancellation will be given with respect to General Liability.
r'.FRTIFIr-ATF Flnl nFR CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Fort Collins
ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 580
AUTHORIZED REPRESENTATIVE
Fort Collins CO 80522Rj
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