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HomeMy WebLinkAbout413403 OTAK INC - INSURANCE CERTIFICATE (4)Client#: 53352 OTAKINC ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATENYYY) 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 NANTACT ME: Carly Underwood PHONE 770.552.4225 FAX AIC, No Eli: Alt No: 866.550.4082 E-MAIL carl underWood re IIn ADDRESS: Y• @g Y g•tom Alpharetta, GA 30022 NSURER(S) AFFORDING COVERAGE NAICX INSURER A: The Phoenix Insurance Company 25623 INSURED INSURER B : Travelers Indemnity Company 25658 Otak, Inc. Beazle Insurance Company, Inc. INSURER C : Y Y. 37540 808 SW Third Avenue, Suite 300 INSURERD: Travelers Indemnity Company of America 25666 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. LTR TYPE OF INSURANCE NSRR ADDL SUBR WVD POLICY NUMBER MM DDYNYYY MEFF M DDY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR 6805H2424691847 1/01/2019 01/0112020 EACH $1 000000 �OCCURRENCE PREMISES Ea oau ran.) nte $1 000,000 MED EXP (Any one person) $ 5 000 PERSONAL &.ADV !NJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY X JECT ^I LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 $ D AUTOMOBILE LIABILITY RANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS AHIRED UTOS ONLY �( NON -OWNED AUTOS ONLY BA1502P89218GRP 1/01/2019 01/01/202 EeaocdeDSINGLELIMIT 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE$ Per accident B X B �BRELLALIAB XOCCUR CLAIMS -MADE CUP5C8570811847 1/01/2019 01/011202 EACH OCCURRENCE $1O 000 000 AGGREGATE $1O 000 000 RETENTION $10000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe 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 1/01/2019 01/01/202 Per Claim $2,000,000 Aggregate $4,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is requlrod) Re: Fort Collins on -call PSA. City of Fort Collins Attn: Jennifer Shanahan or Purchasing Dept PO Box 580 Fort Collins, CO 80522-0000 L,AN9,t_LL.A I IUN 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 ACORD 25 (2016/03) 1 of 1 #S1356284/M1353893 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CUND1