HomeMy WebLinkAboutCIGNA HEALTH AND LIFE INSURANCE COMPANY - INSURANCE CERTIFICATE (2)"R" CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
04/30/2019
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).
CONTACT
PRODUCER NAME:
Marsh USA Inc. PHONE - FAX
1717 Arch Street (A/C No. Ext) _ I tA/c,
Philadelphia, PA 19103-2797 ADDRESS:
— ---
Attn� rloalthrara ArcnnntcCSS(nlmarsh rom FAX 212-948-1307 --
CN101510211-PRIKCRIME-19-20
INSURED
CIGNA HEALTH AND LIFE INSURANCE
COMPANY
900 COTTAGE GROVE ROAD
BLOOMFIELD, CT 06152
l�CL]TILIP`ATC 11,11 IRAMCO
_ INSURER(S) AFFORDING COVERAGE NAIC #
URER A : National Union Fire Insurance Co. of Pittsburgh PA 19445_
URER B
URER C :
URER D :
URER E :
URER F :
rll F-Mr,17d997-11 RFVICI0fJ NIIMRFR- 1
THISISTO 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� ADDL SUBR POLICY EFF POLICY EXPO LIMITS
LTR TYPE OF INSURANCE INSD I Z8a POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE _ _
$ _
CLAIMS -MADE [� OCCUR
-
DAMAGE T RENTED
PREMISES Ea occurrence
$
MED EXP (Any one person)
$
PERSONAL& ADV INJURY
$
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$
PRODUCTS -COMP/OP AGG
_
$
POLICY ❑ PRO ❑ LOC
JECT
OTHER
AUTOMOBILE LIABILITY
CEOMBINEDISINGLE LIMIT
_La acciANY
$
BODILY INJURY (Per person)
$
AUTO
BODILY INJURY (Per accident)
$
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
L
PROPERTYDAMAGE
Per accident
$
$
UMBRELLA LIAR
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAR
CLAIMS -MADE
DEDT I RETENTION $
$
WORKERS COMPENSATION
PERT OTH-
STALITE ER
AND EMPLOYERS' LIABILITY
ANYPROPRIETOR/PARTNER/EXECUTIVE Y❑
—
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
NIA
E L DISEASE -POLICY LIMIT
$
If yes, describe under
DESCRIPTION OF OPERATIONS below
A
CRIME/FIDELITY
01-354-33-55
04/30/2019
04/30/2020
LIMIT
$5.000,000.
DEDUCTIBLE
$2,500,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EVIDENCE OF COVERAGE
CERTIFIGAIE HULUtK 11v114 --
CITY OF FORT COLLINS
215 NORTH MASON STREET
FORT COLLINS, CO 80524
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
of Marsh USA Inc.
ManashiMukherjee _JVtVL%.+.a►
V 19SS-ZU1b AGUKU GUKVUKA I IUrv. Flll rignis reserves.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD