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ACX--Wzo CERTIFICATE OF LIABILITY INSURANCE DATE (MV)
�/- 09/21/201/2019
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:
Willis Florida, Inc. PHONE 1-877—
Ce945-7378 , 1-888-467-2378
c/o 26 Century Blvd E-MAIL
P.O. Box 305191 . csrtificatesewillis.com
Nashville, TN 372305191 USA ,........-...... .,.�....,......-..��.-� .._._ ..
INSURERA: National Onion Fire Insurance Company of P19445
INSURED--_� INSURERB: New Hampshire Insurance Company 23841
Goa Secure Solutions (OSa) Inc.
1395 University mivd. INSURER C: _
Jupiter, FL 33458 INSURER ID;
INSURER E :
INSURER F: _
COVFRAAFC CFRTIFICATF NI148RF12- W22958849 GCVICIn AI Mr taaDCO.
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 --- -- 'ADDL SUBR -- POLICY EFF POLICY EXP-------
LTR TYPE OF INSURANCEINSID WVD POLICY NUMBER D(YYYY) (MM/DDIYYYYI LINTS
X COMMERCIAL GENERAL LIABILITY !
EACH OCCURRENCE
'$ 1,000,000
. CLAIMS -MADE X OCCUR
PREMISES a cco rrr e
$ 1, 000, 000
$ Excluded
A
Y DL 686-24-20 I110/01/203.9
10/01/2020
MED EXP (Any oneperson)
PERSONAL A ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
I $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY _ JE� LOC
PRODUCTS-COMP/OP AGO
$ 1,000,000
OTHER
Is
AUTOMOBILE LIABILITY
_
COMBINED BINDLE LIMB
Ea accident $ 1,000,000
BODILY INJURY (Per Person) $
X ANY AUTO !
A
OWNED SCHEDULED Y CA 499-32-50 (AOS) 10/01/2019
NLV AO
10/01/20201
BODILY INUURV IPer accident)
$
HIREDAUTOS NON -OWNED
HIRED O
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
FLPer &CCO A
$ _
_
Is
UMBRELLA LIAB _'OCCUR
EACHOCCURRENCE
$
AGGREGATE
$
EXCESS OAB CLAIMS -MADE
_ _
DED RETENTION$
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y f N
8 ANYPROPRIETOFVPARTNERIEXECUTIVE I
OFFICERMEMBER EXCLUDED? No NfA MC 017-51-5817 (ADS) I10/01/2019
(Mandatory In NH)
II yes. describe under
DESCRIPTION OF OPERATIONS beow I
10/01/2020�
X TAT T
E.L. EACH ACCIDENT
E.L. DISEASE EA EMPLOYEE
$ 11000,000
$ 1, 000, 000
E.L. DISEASE - POLICY LIMIT
$ 11000, 000
i
DESCRIPTION OF OPERATIONS LOCATIONS VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached it more space is required)
See Attached:
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Fort Collins, Colorado
Attn: Purchasing Department AUTHORIZED REPRESENTATIVE
PO Box 580
Fort Collins_ CO 80522
1988-2016 ACORD CORPORATION. All rights reserved_
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
$9 To: 18552746 BATCH 1377349
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