Loading...
HomeMy WebLinkAbout474315 REVENUE RECOVERY GROUP INC AND DISCOVERY AU - INSURANCE CERTIFICATE (4),4c RO D® CERTIFICATE OF LIABILITY INSURANCE DATE(MM.DDYYYY) `r►�" 6/5/2019 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 NAME: Renee Meaux Arthur J. Gallagher Risk Management Services, Inc. -PH IJ F — 235 Highlandia Drive, Suite 200 • 225-906-1271 /� Nc ; 225-292-3893 Baton Rouge LA 70$10 E-MAILnpoRE$s_ renee_meaux@ajg.com INSURED REVEREC•02 Revenue Recovery Group, Inc.,- Discovery Audit Sery 12012 Bricksom Avenue Baton Rouge, LA 70816 INSURERS) AFPORDING COVERAGE INSURER A: American Fire and Casualty Company INSURERS: Ohio Casualty Insurance Company Union Insurance COVERAGES CFRTIFIrATF NI IMRFR• 1SR-4AA9QQ RFVICIr%KI "I 11101RGR• NAIC # 24066 19038 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 i— _ _. __� LTR TYPE OF INSURANCE wvpPOLICY NUMBER MMIDD YYYY O Y EXP LIMITS A X COMMERCIAL GENERAL LIABILITY ,__, J CLAIMS -MADE �l OCCUR BZA57693820 6/16/2019 6/18/2020 EACH OCCURRENCE AMADiE`rCjliEjLEb_ pp�NtlfD ,D00,000 _ +_$000 MED FJfP..SAaonaparson) $ 529Do_ PERSONAL & ADV INJURY $ GEWL AGGREGATE LIMIT APPLIES PER: PRO- F POLICY JECT LOC GENERAL AGGREGATE $ 4,000,000 PRODUCTS - COMP/OP AGG $ 4,000,000 $ OTHER', A AUTOMOBILE LIABILITY BZA57693820 6/18/2019 6/16/2020 OOMSINIED SINGLE OMIT (Ea accidtird) $1,000,000 ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X HIRED �(NON-OWNED AUTOS ONLY AUTOS ONLY PROPERTYDAMAO-E P r n $ B X UMBRELLA LIAR X OCCUR US057693820 8/18/2019 WIW021 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 EXCESS LIAB�CLAIMS-MADE_ DIED! j I RETENTION $ in rinn $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A UBOL5678141942G 6/16/2019 8/18/2020 X PTAT T RH E.L. EACH ACCIDENT ______. — $ 1.000,000 _ (Mandatory in NH) By@ s. describe under DEBCR IPTION OF OPERATIONS below E.L. DISEASE - EA EMPLOYEE -----.—--__�_.._ E.L. DISEASE - POLICY LIMIT $1,000.000 I $1,000,000 A Employee Benefits Liability D Professional Liability I BZA57693820 6/16/2019 6/16/2020 Aggregate Umit EONLAF112758374 6/16/2019 6/16/2020 Aggregate Limit I $2,000,000 $3.000.000 DESCRIPTION OF OPERATIONS / LOCATIONS VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Complete Named Insured for the Liability Policy: Revenue Recovery Group, Inc. and King Woolf Discovery Audit Services, LLC Complete Named Insured for the Workers Compensation Policy: Revenue Recovery Group, Inc. Discovery Audit Services, LLC See Attached... 1 rz rS 1 1 City of Fort Collins Jolene Buxman PO Box 580 Fort Collins CO 80522 USA 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 2' of 4 14793 AGENCY CUSTOMER ID: REVEREC-02 LOC #: A R ® ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Arthur J. Gallagher Risk Management Services, Inc. NAMED INSURED Revenue Recovery Group, Inc.; Discovery Audit Sery 12012 Bricksom Avenue Baton Rouge, LA 70816 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 _ _ FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE General Liability Endorsement: Additional Insured (Owners, Contractors or Lessors) - Blanket When Required by Written Contract - BP04020106 Commercial Umbrella Endorsement: Waiver Transfer Rights of Recovery Against Others - CU64951207 Cyber Liability - 6/6/2018 - 6/6/2019: Policy Limit of Liability - $10,000,000 Each Claim or Event Rentention - $10,000 Aggregate ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 3` of 4 14793