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HomeMy WebLinkAbout413403 OTAK INC - INSURANCE CERTIFICATE (3)Client#: 53352 OTAKINC ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(YYYY) 12/27/207/2018 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 Alpharetta, GA 30022 CONTAC NAME: Carly Underwood HONnE t:770.552.4225 F aC, N.: 866.550.4082 E-MAIL ADDRESS: carly.underwood@greyling.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: The Phoenix Insurance Company _ 25623 INSURED - Otek, Inc. 5777 Central Avenue, Suite 228 Boulder, CO 80301 INSURER B : Travelers Indemnity Company 25658 Beazle Insurance Company, Inc. INSURERC: y P Y. 37540 INSURER D : Travelers Indemnity Company of America 25666 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 CONTRACTOR 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. LTR TYPE OF INSURANCE NSR WVD POLICY NUMBER MM/DDY EFF M�CDY EXP LIMITS A X COMMERCIALGENERALLIABILITY CLAIMS -MADE (OCCUR 680SH2424691847 1/01/2019 01/01/2020 EACH $1,000,000 ��OCCURRENCE PRE MISESOE.occurrence $1,000,000 MED EXP (Any one person) $ 5 000 PERSONAL R ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 51 JECOT I LOC OTHER: I GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 $ D AUTOMOBILE X X LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY BA1502P89218GRP 1/01/2019 01/01/202 Ea MBINED a.id.n1SINGLE LIMIT 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ B X UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE CUPSC8570811847 1/01/2019 01/01/2020 EACH OCCURRENCE $10000 000 AGGREGATE $1 O 000 000 DED I X I RETENTION $10000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, descnbe under DESCRIPTION OF OPERATIONS below N I A PER OTH- T T E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ C Professional Liability V10267191001 110112019�01101121 Per Claim $2,000,000 Aggregate $4,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) The City, its officers, agents and employees are ncluded as additional insureds on the general and auto liability with regard to operations of the named insured subject to policy terms, conditions and exclusions per attached form CGD381 & ; Cancellation provisions apply per attached form ILT40503 City of Fort Collins, Attn: Jennifer Shanahan PO 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 IC4/v- ACORD 25 (2016/03) 1 of 1 #S1356282/M1353893 © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CUND1