HomeMy WebLinkAbout582778 CORVEL ENTERPRISE COMPANY - INSURANCE CERTIFICATE (3)CERTIFICATE OF LIABILITY INSURANCE 1 D;,�;IM20019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVE Y AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOTCONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATEMiOLDER.. _
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVEDterms , subject to the tes 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 endorseme s .
PRODUCER
MARSH USA INC.
540 W. MADISON
CHICAGO, IL 60661
Attn: dticago.Ceff*uest@mmzh.com
Travelers
INSURED
CorVel Enterprise Comp, Inc.
Attn:Jay Ulleda
2010 Main Street, Suite 600
Irvine, CA 92614
rn�rcown_cc t-=v-n0U`AT5= t ingir-R• I CHI.008291973.16 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 OIj
CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE
-SHOWN
AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS
MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE --_
D LSUBR
PO
CY.NUMBER
MMIDD/YYYY
MMILIDN XF
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
TJGLSA280-K50 5TIL19-
04130/2019
04/30/2020
EACH OCCURRENCE
$ 1,000,000
DAMAGE To RERTE13--
PREMISES Meobburrence
$ 1,00000
CLAIMS-WADE a OCCUR
MED EXP (Any oneperson)
$ 10,000
PERSONAL a ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
POLICY PRO- LOC
JECT
a
OTHER:
A
AUTOMOBILELLABILTTY
TJCAP28OK5102TIL19
0413012019
04/30/2020
C8 BONEDaccidenSINGLE LIMIT
$ 1,000,000
BODILY INJURY (Per person)
It
X ANY AUTO
BODILY INJURY (Per accident)
$
OWNED F I SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
I
PROPERTY. DAMAGE
Per accident
$
AUTOS ONLY AUTOS ONLY
CorWJC011. DO.
$ 500
UMBRELLA LIMB
OCCUR
I
EACH OCCURRENCE
$
AGGREGATE
-$
EXCESS LIMB
CLAIMS -MADE
DIED I I RETENTIO:J $
$
A
WORKERS COMPENSATION
TC2JUB28OK517119(ADS)
X STOT
ATUTE ER
A
AND EMPLOYERS' LIABILITY YIN
iRIUB280K50�319
(AZ,MA,NE,WI)
0413012019
04I3012020
E.L. EACH ACCIDENT
$ 1,000,000
ANYPROPRIETOR/PARTNER(EXECUTIVE
FN
NIA
E.L. DISEASE - EA EMPLOYE
$ 1,060,000
OFFICER./MEMBER EXCLUDED?
(Mandatory In NH)
E.L. DISEASE -. POLICY LIMIT
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
_
C
Managed Healthcare Prof. Liab.
MSP G27108617
007 (SIR: $500,000)
10/3112019
10/31/2020
Per Clam
5,000,000
Aggregate
5,000.000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 101. AddlUonai
Remarks Schedule, may he attached if more space is required)
The City of Fort Colins its officers, agents and emptoyees are included as Additional Inslured
under the General Liability and Auto Liability policies as their interest may appear, but only to the extent such status is
required under their wrihen contract / agreement with the Named Insured.
TIFICATE HOLDER I CANCELLATION
CER
City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Aim: Gerry Paul THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
215 North Mason AdCORDANCE WITH THE POLICY PROVISIONS.
PO Box 580
FOR Coffins, CO 80522 AUTHORIZED REPRESENTATIVE
of Wrsh USA Inc.
Manashi Mukhedeesn-
W 18S11-1U16 AGi
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
IJVKMVKA I IVK. Au rigms reServeu.
W 18S11-1U16 AGi
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
IJVKMVKA I IVK. Au rigms reServeu.