HomeMy WebLinkAbout474315 REENUE RECOVERY GROUP INC - INSURANCE CERTIFICATE (2)CERTIFICA'
OF LIABILITY INSURANCE
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 INOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: It the certificate holder Is an ADDITIONAL, INSURED, the policy(les) 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
Arthur J. Gallagher Risk Management Services, Inc.
235 Highlandia Drive, Suite 200
Baton Rouge LA 70810
Revenue Recovery Group, Inc./ Discovery Audit
11637 Lake Sherwood Ave N
Baton Rouge, LA 70816
0
Travelers
and
24066
THIS IS TO CERTIFY THAT'THE_POUCIES 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.
ILR
TYPEOFINSURANCE
DOT
ID
WVO
I.POUCYNUMBER
WOYP�{{JCFXP
MM/Y
LaRTS .
A
X
COMMERCIALGENERALLIABiUTY
Y
Y
BZA57693820
6/16/2019
6/162020
EACH OCCURRENCE
$2,000.000
CLAIMS -MADE Fil OCCUR
It IVKIzNIt:U
PREMISES Ea occurrence
$50,000
MED EXP (Anyone person)
$ 5.000
-
PERSONAL &ADV.INJURY
$
GEN'L
AGGREGATE LIMIT APPLIES PER:
GENERALAGGREGATE
$4,000,000'
X
POLICY ❑JECT LOC
PRODUCTS-COMP/OP AGG
$4,OD0;000
$
OTHER:
A.
AUTOMOSILELIABILRY
Y
Y
BZA57693WO
61162019
6/162020
C041aB10NdeDISINGLE LIMIT-
$1,000,000
BODILY INJURY (Per person)
$
ANY. AUrO
OWNED SCHEDULED
AUTOS ONLY
BODILY INJURY (Per accident)
$
X
Par a 'd I' DAMAGE
� Per accident
$
X NAUTOS
ON -OWNED
HIRED X NON -OWNED
AUTOS ONLV AUTOS ONLY
E
B
X
UMBRELLA UAB
X OCCUR
Y
Y
US057693820
6/162019
ISM62020'
EACH OCCURRENCE
$1,000.000
AGGREGATE
$1,000,000
EXCESS UAS
CLAIMS -MADE
DED I X .RETENTIONS in nr)6
$..
C
WORKERS COMPENSATION
AND EMPLOYERS' ABILITYUY / N
ANYPROPRIETOPJPARTNER/ExrcunVE
OFFICERIMEMBEREXCLUDED?
(Mandatory In NN)
N / A
Y
UB0L5678141942G
6/162019
SM62020
PER
X STATUTE
H;
-ER.
E.L. EACH ACCIDENT
$1,000,000 .
E.L. DISEASE - EA EMPLOYEE
$'I 000,000
II M. describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE- POLICY: LIMIT
S 11000,000
D
Emdbyee Benefits Uabltity
Pro essional Uabllty
Y
Y
BZA57693820
EONLAF112758374
61162019
6/11201/
6N62020
61162020
AggreOateUm¢
Aggregate Umrt
t:2000,000
$3,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional
Rai. e" Schedule. may be attached If more space to recrutrod)
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...
City of Fort Collins
P.O. Box 590
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.
ACORD'25 (2016/03)
01968-,2015 ACI
The ACORD name and logo are registered marks of, ACORD
AGENCYCUSTOMER ID: REVEREC-02
LOC #:
'REMARKS SCHEDULE Page 1 of i
Arthur J. Gallagher Risk Management Services, Inc. Revenue Recovery Group, Inc./ Discovery Audit
11637 Lake Sherwood Ave N
POUCY NUMBER Baton Rouge, LA 70816
CA MER NAIC CODE
_..
EFFECTIVE DATE: -
ADDITIONAL REMARKS
i
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
1. FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE
General Liability Endorsement I
Additional Insured (Owners, Contractors or Lessors) - Blanket When Required by Written Contract - BP04020106
I Umbrella Endorsement:
isfer Rights of Recovery Against Others - CU64951207
lity - 6/1612019 - 6/16i2020:
of Liability _$10,000,000 Each Claim or Event
$10,000 Aggregate
101 (200SZ) ® 2008 ACORD
The ACORD name and logo are registered marks of ACORD