HomeMy WebLinkAbout474315 REENUE RECOVERY GROUP INC - INSURANCE CERTIFICATE (3)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 NEG 71VELY 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 poiicy(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(a).
ArthurJ. Gallagher Risk Management Services, Inc..
235 Highlandia Drive, Suite 200
Baton Rouge LA 70810
INSURED
Revenue Recovery Group, Inc. and Discovery Audit
12012 Bricksom Avenue
Baton Rouge, LA 70816
Renee Meaux
:American Fire and Caw
Ohio Casualty Insurance
INSURERD: Illinois UnionInsuranceComDanv 1 27960 1
COVERAGES CERTIFICATE NUMBER:.309270838 REVISION NUMBER:
THIS IS TO CERTIFY THAT -THE -POLICIES OF INSURANCE LISTED
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM
BELOW HAVE BEEN ISSUED TO THE INSURED -,NAMED -ABOVE FOR THE POLICY PERIOD
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.
LTA
TYPEOFINSURANCE
INSD ADDL
WBR
POtJCY NUMBER.
-MY aIW�YY.
MMYCY YXP
LIMITS:
A
X
COMMERCIAL GENERALLIABILfrY
Y
Y
BZA57693820
6/16/2019
6/16/2020
EACH OCCURRENCE
$2:000:000
CLAIMS -MADE F71 OCCUR
occurrence)_
Eone
$50.000
MPperson)
$5,000
PERSONAL &ADV.INJURY
$
GEN'L
AGGREGATE LIMIT APPLIES PER:
GENERAL. AGGREGATE
$4,000,000
X
POLICY 71 JEC-
-
PRODUCTS-COMP/OP AGO
$4000,000
$
OTHER:
A
ALITOMOBILELIABILITY
Y
Y
BZA576
3820
- 5116/2019
6/16/2020
0 IINNIED SINGLE LIMIT
0.11
$1,000,000
BODILY INJURY (Per, person)
$
ANY AUTO
OWNED AUTOS ONLY UTOSULED
130DILY IWURY(Peraccident)
S
X
--
PROPERTYDAMAGE
Per:accidem
$
HIRED X NON -OWNED
AUTOS ONLY — AUTOS ONLY
_
E
B
X
UMBRELLA LIAR
X OCCUR
Y
Y
US057693820
61162019
6116/2020
EACH OCCURRENCE
$1,000,000
AGGREGATE
$1,000,000
t7CCESS LIA8
CLAIMS -MADE
DED I X I RETENTIONSin nnn
_
$
C
AND EMPS YERS'LI ATON
AND EMPLOYERS' LIABILITY y r N
ANYPROPRIETOR/PARTNER/EXECUTIVE ❑"
OFPICER/MEMSEREXCLUDED7
N / A
Y
UBOL5678141942G
6/162019
61162020
X STATUTE ER:
E.L. EACH ACCIDENT
$1,000,000
(111endatory In NH)
E.L. DISEASE- EA EMPLOYEE
s t000,000
-
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE -,POLICY LIMIT
E 1'000'000
A
0
EmoloYae Benefits Liability .. -
11 ty
Pro esslonal Liability
V
Y
82A67890820
EONLAF112758374
_,1
81162019
6/16/2019
..d
61162020
61162020
_.. . _
AB9repakCimit -
A99re9ate Umlt
$2000,000
$1,000,000
DESCRIPTION OP OPERATIONS l LOCATIONS / VEHICLES I-ACORD 101, Addlrlon_
al,Rem ells Schedule, may. be atleched If more space ls, requhed)I
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...
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Clfy of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS.
P. , Box 580
Fort Collins CO 80522 AUTHORIZED REPRESENTATIVE
USA
®19W2015 ACORD CORPORATION. A" rights, reserved.
___ The ACORD name and logo are registered marks of ACORD 2• of 3 20184
AGENCY CUSTOMER ID: REVEREC-02
LOC #:
ADDITIONAL REMARKS SCHEDULE Page i of 1
AGENCY
Arthur J. Gallagher Risk.Management Services, Inc.
-
NAMED INSURED
Revenue Recovery Group, Inc. and Discovery Audit
1201ZBricksom Avenue
Baton Rouge, LA 70816
Poucr NuMsm
CARRIER - -
NAIC CODE
EFFECTIVEDATE:.
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE
mal,lnsured (Owners, Contractors or Lessors) —Blanket
ercial Umbrella Endorsement:
r Transfer Rights of Recovery. Against Others= CU6495
Liability - 6/16/2019 - 6/1612020:
Limit of Liability - $10,000,000 Each Claim or Event
ltion - $10,000 Aggregate
Required by Written Contract— BP04020106
101 (2008101)
The ACORD name and logo are registered marks of ACORD
3' of 3 20164