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Home My WebLink About628671 RACHIO INC - INSURANCE CERTIFICATEDATE (MM/DD/YYYY) AFRO® CERTIFICATE OF LIABILITY INSURANCE 1/16/2019 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 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 IMA Select LLC PHONE FAX 1705 17th Street • 303-534 4567 A/c No : 303 534-0600 Suite 100 n IESS: certrequestden@imacorp.com Denver CO 80202 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Hanover American Insurance Company 36064 INSURED RACHINC-01 INSURERB: Philadelphia Indemnity Insurance Co. 18058 Rachio, Inc 1321 15th Street INSURER c : Denver CO 80202 INSURER D : COVERAGES CERTIFICATE NUMBER:600479601 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. INTRR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMMDY/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY OZ4A200900 1/15/2019 1/15/2020 EACH OCCURRENCE $1,000,000 CLAIMS -MADE 1XI OCCUR DAMAGE TO RENTED - PREMISES Ea occurrence s 300,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- ❑ ❑ JECT LOC PRODUCTS -COMP/OPAGG $2,000,000 $ OTHER: A AUTOMOBILE LIABILITY OZ4A200900 1/15/2019 1/15/2020 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X HIRED N NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ A X UMBRELLA LIAB X OCCUR OZ4A200900 1/15/2019 1/15/2020 EACH OCCURRENCE $ 8,000,000 AGGREGATE $ 8,000,000 EXCESS LIAB CLAIMS -MADE DED X RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N I PER OTH- STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N / A E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ B Employment Prac. Liab. PHSD1401927 1/15/2019 1/15/2020 Retention $5000 Agg Limit. 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 30 day notice of cancellation provided to certificate holder per policy terms and conditions. Certificate Holder is included as Additional Insured on the General Liability and Automobile Liability policies, if required by written contract or agreement subject to the policy terms and conditions. CERTIFICATE HOLDER 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. ATTN: Purchasing Dept ATTN: Liesel Hans AUTHORIZED REPRESENTATIVE PO BOX 580 Fort Collins CO 80522 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD