HomeMy WebLinkAbout582778 CORVEL ENTERPRISE COMPANY - INSURANCE CERTIFICATE (2)DATE (MM/DDYYY)
A D® /YCERTIFICATE OF LIABILITY INSURANCE 04/25/2019
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
MARSH USA INC. -NAME:
PHONE FAX
540 W. MADISON 1AXr_ No. EX - (A/C, No): _
CHICAGO, IL 60661 E-MAIL
Attn: chicago.CertRequest@marsh.com ADDRESS:
INSURER(SI AFFORDING COVERAGE NAIC #
INSURER A: Travelers Property Casualty Company of America 25674
INSURED
N CorVel Enterprise Comp, Inc. INSURER B : N/A NIA
Attn: Jay Villeda INSURER C : Illinois Union Insurance Company 27960
2010 Main Street, Suite 600
Irvine, CA 92614 INSURER D
I I INSURER F I I
CnVFRAGFR CFRTIFICATF NIIMBFR: CHI-008291973-13 REVISION NUMBER: 7
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.
LICY EFF POLICY EXP
INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER M
LTR /DD/YYYY MM/DD/YYYY LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
TJGLSA28OK5095TIL19
04/30/2019
04/30/2020
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE F_x] OCCUR
DAMATO RENTED
PREMISES Ea occurrence
$ 1,000,000
MED EX_P (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
POLICY PRO JECT 5J nLOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
OTHER
A
AUTOMOBILE LIABILITY
TJCAP280K5102TIL19
04/30/2019
04/30/2020
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
BODILY INJURY (Per person)
_
$
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
rX
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident)
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
Comp./Coll. Ded.
$ 500
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
Ll
AGGREGATE
$
EXCESS LAB
CLAIMS -MADE
DED I I RETENTION $
$
A
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? FN]
(Mandatory in NH)
N/A
TC2JUB280K507119(ADS)
TRJUB28OK508319 (AZ,MA,NE,WI)
04/30/2019
04/30/2020
04/30/2020
X PER OTH-
STATUTE ER
E.LEACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E L DISEASE - POLICY LIMIT
1,000,000DESCRIPTION
$
If yes describe under
OF OPERATIONS below
C
Managed Healthcare Prof. Liab.
MSP G27108647 006 (SIR: $500,000)
10/31/2018
10/31/2019
Per Claim
5,000,000
Retro date: 04-10-1987
Aggregate
5,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
The City of Fort Collins its officers, agents and employees are included as Additional Insured under the General Liability and Auto Liability policies as their interest may appear, but only to the extent such status is
required under their written contract / agreement with the Named Insured,
City of Fort Collins
Attn: Gerry Paul
215 North Mason
PO Box 580
Fort Collins, CO 80522
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.
Manashi Mukherjee
U 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD