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HomeMy WebLinkAbout413403 OTAK INC - INSURANCE CERTIFICATE (2)Clientfb- 53352 [eft 1111FA 11411 rr ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 1 12/27/2018 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER Greyling Ins. Brokerage/EPIC 3780 Mansell Road, Suite 370 CONTACT NAME: Carly Underwood arc° No Ea1:770.552.4225 Arc AX No: 866.550.4082 ADDRESS: carly.underwood@greyling.com Alpharetta, GA 30022 INSURER(S) AFFORDING COVERAGE NAIC e INSURER A: The Phoenix Insurance Company 25623 _ INSURED INSURER B : Travelers Indemnity Company 25658 Loris and Associates, Inc. an Otak INSURE RC : Beazley Insurance Company, Inc. 37540 Division Travelers Indemnity Company of America INSURER D: Y P Y 25666 808 SW Third Avenue, Suite 300 Portland, OR 97204 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 19-20 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. LTRR TYPE OF INSURANCE IN RL WVD POLICY NUMBER MMIDDY EFF MMIDDY/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR 6805H2424691847 l/01/2019 01/01/202 EEACH $1 OOOOOO �OECCURRENCE PREMISES F.olccurrence $1 000,000 MED EXP (Any one person) s5,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY � JE � FX LOC OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 1 $ D AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS AHIRED UTOS ONLYXNON-OWNED AUTOS ONLY IX BA1502P89218GRP 1/01/2019 01/01/202 Ea ac,ccdeDSINGLE LIMIT 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE I CUP5C8570811847 D110112019 01/01/2020 EACH OCCURRENCE $10000000 AGGREGATE $1 O 000 000 DIED I X RETENTION $10000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTNE OFFICER/MEMBER EXCLUDED? 171 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A J.PERT OTH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ C Professional Liability V10267191001 1/01/2019 01/01/202 Per Claim $2,000,000 Aggregate $4,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) All operations of the named insured subject to policy terms, conditions and exclusions. City of Fort Collins 215 N. Mason St., 2nd Floor, P.O. Box 580 Fort Collins, CO 80522-0000 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 4d/E% ACORD 25 (2016/03) 1 of 1 #S1356281/Ml353893 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CUND1