HomeMy WebLinkAbout113272 VISION SERVICE PLAN - INSURANCE CERTIFICATE (2)ALA o- CERTIFICATE OF
LIABILITY INSURANCE 10/1/2020
DATE(MMMONYYY)
11/1/2019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,
BELOW. THIS CERTIFICATE OF INSURANCE. DOES NOT CONSTITUTE
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOIJAER.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
IMPORTANT: H the certificate holder Is an ADDITIONAL INSURED,
if SUBROGATION IS WANED,. subject to the torms and conditions
this certificate does not confer rights to the certificate holder In
the poiley(les) must have ADDITIONAL INSURED provisions or be endorsed.
of the polity, certain policiesmay require an endorsement A statement on
Ileu of such endarsement(s).
PRODUCER Lockton Insurance Brokers, Inc.
400 Capitol Mall Avenue, Suite 2600
Sacramento CA 95814
(213)68M550
M
P
FAX
AIC No,Exe : Ale No),
E.MaL
INSUREFUSI AFFORDING COVERAGE
.INSURER A: National Fire Insurance Co.ofHartford-
20478-
INSURED Vision Service Plan
1421518 3333 Quality Dr.
Rancho Cordova CA W70-9757-
INSURER B _; the COatmente insurance .Company289
INSURER c :. SafetyNational Casual Corporation
5
--
INSURER n
r-_AVFQAPFR VTQQpol CFDTIFICATF MIIIURFR•1
Id2A'34nk OFVIRIAM MIIru1RFD• YYYYYYY
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 CSSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWNWAY HAVE BEEN REDUCED -BY PAID CLAIMS.
INSRall
TYPE OF INSURANCE
ADDL
BR
POLICY
NUMBER ---
FF:
-PO IC .EXP".
- - - _-- --- LIMBS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
SIR/neA_S2innn
Y
N
6075948164
11/1/2019
11/1/2020
EACH
OCCURRENCE
s 1000000.
DAMAGE TO RENTED
MED EXP An one non
1,000,060
S 15,000
PERSONAL & AOV INJURY
"
$ 1000666
-GEN'L AGGREGATE LIMIT APPLIES PER: -
POLICY❑ JE O LOC
OTHER:
GENERAL AGGREGATE
$ 2000000
PRODUCTS - COMPIOP AGG
$ 2 OOO OOO
$
:ALrtO1tOBILELIABILT'
X A��NWyyY AUTO
ONSI ONLY AUTO
HIRED - NOµ�g3WN LD
AUTOS ONLY AUTOS ONLY
Y
N
6075642981
11/1/2019
11/1/2020
OMBINEDSINGLE LIMIT
$ 1 000000
BODILY INJURY (Per Person)
$ XXXi{��
BODILY INJURY (Per accident
$ XXXXX��
PROPERTY DAMAGE
$X( �(
Corri /Coll Ded.
$ $1 000
_
UMBRELLA LIAR
Excel LIAI
OCCURR
CLAIMS -MADE
_
NOT APPLICABLE
�.
I -
- -
EACH OCCURRENCE
$ XXXXXXX
GGREGATE
$ XXXXXXX
DED RETENTION $
$
C
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANVPROPRIETORIPARTNERIEXECIJfIVE
OFFICERMEMBER EXCLUDED? N❑
rMaendatcry in NH)
If ys
DESCRIPTIONOFOPERATIONS Wm
NIA
NYIN
LDM404%8/�2(AOS)
PS4049683'("
10/1/2019
10/1/2019
10/1/2020
10/1/2020
PERO
X. STATUTE
LEACHACGDENT
$ 1,000,000
.L DISEASE -EA EMPLOYEE
1000000
.L DISEASE - POUCY LIMIT
C I OOO OOO
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addhionel
City of Fort Collins are Additional` Insured to the extent provided by
Remarks Schedule, maybe attached N mom apace Is requbad)
the policy language or endorsement issued or approved by the insurance carrier..
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE E%PIRATK)N DATE THEREOF, NOTICE MILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
14383308
City of Fort Collins
PO Box 580
Ft Collins CO 80522
25 (2016/03) 1@ 1988.201 MCORD CORPORATION. All
The ACORD name and logo are registered marks of ACORD