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HomeMy WebLinkAbout113272 VISION SERVICE PLAN - INSURANCE CERTIFICATEAr_o>R" CERTIFICATE OF LIABILITY INSURANCE 16. - 10/1/2019 DATE(MM/DD/YYYY) 1 11/1/2018 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 Loddon Insumnce Brokers Irtc 400 Capitd NUI Avenue, Sute 26W Saaarmlo CA 95814 (213) 689-0550 CONTACT ME: PHONE FAX A C, No Ext : AIC, No): E-MAIL ADDRESS: INSURER AFFORDING COVERAGE NAIC # INSURER A: National Fire Insurance Co of Hartford 20478 INSURED Msion Ser\Aoe Flan 1421518 3 ClUditY Dr' Randm Ca ldova CA 95670-9757 INSURER B : The Continental Insurance Company 35289 INSURER C: Safety National Casualty Corporation 15105 INSURER D : INSURER INSURER F COVERAGES VISSEOI CERTIFICATE NUMBER: 14383308 REVISION NUMBER- XXXXXXX 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 TR TYPE OF INSURANCE ADDL INSD SUER POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR S[R/Ded. $25.000 Y N 6075848164 11/1/2018 11/1/2019 EACH OCCURRENCE 1,000,000 DAMAGE PREMISES (Ea oocu ence) $ 1,000,000 X MED EXP (Any oneperson) 15,000 X Liquor Liab. S I M PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY❑ JECOT- ❑ LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMPIOP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY NON-OWNED ONLDY Y I N 6075642987 1 11.'I;'2018 11//2019 COMBIINfEDtSINGLELIMIT $ 1,000,000 X BODILY INJURY (Per person) $ XXXXXXX BODILYINJURY(Peraccident $ XXXXXXX PROPERTY accide DAMAGE $ XXXXXXX Comp/Coll Ded. $ S1 000 UMBRELLA LIAB EXCESS LIABH OCCUR CLAIMS -MADE NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX AGGREGATE $ XXXXXXX DED I I RETENTION $ $ C C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE � OFF ICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A N LDM4049682 AOS) PS4049683(WI) 10/1/2018 10/1/2018 10/1/2019 10/1/2019 PER OTH- X STATUTE ER E.L. EACH ACCIDENT $ 1,000000 E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT 1,000,000 1 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) City of Fort Collins are Addition. ' u. ured to the extent provided by the policy language or endorsement issued or approv ad by the insurance carrier. CERTIFICATE HOLDER CANCELLATION See Attachment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 14383308 AUTHORIZED REPRESENTATIVE OtyOf Fat Cdlins PO Box 580 Ft Wins CO 80522 ACORD 25 (2016/03) ©1 088-201§-ACQfRD C RPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD