HomeMy WebLinkAbout474315 REENUE RECOVERY GROUP INC - INSURANCE CERTIFICATEA� DF CERTIFICATE OF LIABILITY INSURANCE I DATE(MMIODNYY,YI
11hr2019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO. RIGHTS UPON. THE CERTIFICATE HOLDER. THIS,
CERTIFICATE DOES NOT AFFIRMATIVELY OR Ngg4TIVELY AMEND, EXTEND OR ALTER. THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOESI NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holderis an ADDITIONAL INSURED, the pollcy(ies) must have ADDITIONAL INSURED provisions or be endorsed..
If SUBROGATION IS WAIVED, subject to the terms anti conditions of the policy, certain policies may require an endorsement. A statement on
this. certificate does not Confer rights to the eertfficate holder in lieu of such. endorsement(s).
PRODUCER -
Arthur J. Gallagher Risk Management Services, Inc.
235 Highlandia Drive, Suite 200
Baton Rouge LA 70810
INSURED
Revenue Recovery Group, Inc. and Discovery Audit
12012 Bricksorrl Avenue
Baton Rouge, LA 70816
Renee Meaux
American Fire and Casul
Ohio Casualty Insurance
Travelers Casualty and
Illinois Union Insurance
Cl1VFRA('.FR L`FRTIFI/`AT= RI IRRQCQ• nC9C4Cene ewme�u u, use r•e�.
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, TEl
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE
EX_ CLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS
M OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
jSHOWN MAY HAVE,BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
ADDL
SUBRPOLICY
POUCYNUMBER
EFF
p1Y1'
POLICY EXP
DlyyY.
LIMITS
A.
X
COMMERCIAL GENERAL LIABILITY
Y
Y
BZA57593820
6/16/2019
6/161202O
EACH OCCURRENCE
.$2,000.000
DAMAGE TO RENTED
CLAIMS -MADE FXIOCCUR
PREMISES Ea ocmrrenoof
$50,000
MED EXP (Any oneperson)
$ 5,000
PERSONAL B ADV INJURY
$
GEN'L
X
AGGREGATE LIMIT APPLIES PER:.
POLICY ❑PROJECT LOC
GENERALAGGREGATE
$4,000,000
-
PRODUCTS-.COMP/OPAGG
�$4,000,000
$
OTHER:
A
AUTOMOBILE
LIABILITY
AUTO
Y
Y
BZA57693820
6/16f2019
6/1612020
OMBIdNBDSINGLE LIMIT
81;000,000
BODILY INJURY (Per.person)
$
OWNED SCHEDULED
AUTOS ONLY
lANY
BODILY INJURY ( Per accident)
s
x
-
HIRED X. NON -OWNED
NON-O
.AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
Peraccident
$
B
X
UMBRELLALIAB X O.000R
-
Y
Y
USO6�693820
6116/2019
6116/2020
EACH OCCURRENCE
51,000,000-
AGGREGATE
S1,000,000
EXCESS LIAR CLAIMS -MADE
I.DED..
I X RETENTION$.
__.. _ ..$._.
_..
C
.WORKERSCOMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANYPROPRIETOR/PARTNER(EXECUTIVE. ❑
REXCLUDED?
OFFICIEMandatory
N/A
Y
UBOL5678141942G
6I1612018
6/16/2020
X ER
STATUTE ER. .
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE - EA EMPLOYEE
$1;000,000
andan ry In N
($lendetoryin NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY. LIMIT
$1,000.000
A
D
Ernloyee'BenefiitsLlab0lty
Pro lescional.Uabinty
Y
Y
BZA57693820
E0NLAF
1,12758374
61162019
6/16/2019
6116/2020
6/16/2020
AggregatsUma
Aggregate Limit
$2,000,000
$3,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101; AddlUonal
Complete Named Insured for the liability Policy:.
Revenue Recovery Group, Inc. and King. Woolf
Discovery Audit Services, LLC
Remarks Schedule, may. be attached if more space Is required)
Complete Named Insured for the Workers Compensation Po
Revenue Recovery Group, Inc.
Discovery Audit Services, LLC
icy:
See Attached...
City of Fort Collins
P.O. Box 590
Fort Collins CO 80522
USA
SHOULD ANY OFTHE:ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
®1988-2015 ACORD CORPORATION, All rightsreserved. I
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: REVEREC-02
LOC #:
;IC40RD® ADDITIONAL REMARKS SCHEDULE Page 1 of .1 _
.AGENCY -
Arthur J. Gallagher Risk Management Services, Inc.
-
NAMED INSURED
Revenue Recovery Group, Inc. and. Discovery Audit
12012.Bricksom Avenue
Baton Rouge, LA 70816
POUCY NUMBER
CARRIER - -- -
NAIC CODE
EFFECTIVE DATE:.
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORDFORM,
cnam rauruRCR• 25 cnolu TM V. CERTIFICATE OF LIABILITY INSURANCE
Insured (Owners, Contractors or Lessors) - Blanket
cial Umbrella Endorsement:
ransfer Rights of Recovery. Against Others - CU64
ability - 6/.16/2019 - 6/16/2020:
mit of Liability $10,000,000 Each Claim or Event
on - $10,000 Aggregate
Required by Written Contract- BP04020106
® 2008 Al
A01 10112 1 The ACORD na �Iogoare®red marks 01 ACORD
All