HomeMy WebLinkAbout474315 REVENUE RECOVERY GROUP INC - INSURANCE CERTIFICATE (11)A111t, ii�_ Rom® CERTIFICAT OF LIABILITY INSURANCE �snvzozoYY)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFOF MATION ONLY AND CONFERS NO: RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATI ELY AMEND, EXTEND OR ALTER THE COVERAGE; AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES' N T CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER( S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICA rE HOLDER.
IMPORTANT: if the certificate holder is an ADDITIONAL NSUR,ED, the policy(ies) must have ADDITIONAL INSURED Provisions -or endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policles may "require An endorsement. A statement on
this certificate does not confer.richts_to the certificate holder In lleu of such endorsements).
PRODUCER
Arthur J. Gallagher Risk Management Services, Inc
235 Highlandia Drive, Suite 200
Baton Rouge LA 70810
A: American Fire
Revenue Recovery Group, Inc.
11637 Lake Sherwood Ave N
Baton Rouge LA 70816
NI
THIS.IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM
BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVETOR 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 HEREINIS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND.CONDITIONS OF SUCH POLICIES. LIMITS SHOWN
MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
A V DL
1 DI
WVD
- - - _ -
POUCYNUMBEIR
POLICY EFF
-MMIDD/YY
POLICY EXP
MMlDD/YYYY
'ullm
A -
X,
COMMERCIAL GENERAL LIABILITY
Y
Y
137-A57693820
611612020,
6/1612021
EACH000URREN6E
$2,00,000-
CLAIMS-MADE OCCUR
-
PREMISTO ES(E�so�TEDnce)
$501DOD
MED'DO (Any one person)
$ 5; 000
i
PERSONAL&:ADV INJURY
III
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
- $ 4 060,000
PRO- ❑
X POLICY � JECT LOC
PRODUCTS; COMPIOP'AGO
$4,000,000
$'
OTHER:
:A
AIIT6M66ILELIABILrrY
Y
Y
BZA57693620
-
6/16/2020
61162621
DSINGLE.uMli
$1;000;000(Eaadent
BODILY INJURY(Perperson)
$
ANY,AUTO -
OWNED - SCHEDULED
AUTOS ONLYAUTOS
"
BODILY INJURY (Per accident)
$
x
PROPERTY DAMAGE
Per accident
$
HIRED X: NON -OWNED
AUTOS ONLY - AUTOS ONLY
`
B
X
Ukel:u— .ALIAB
X
OCCUR
Y
Y
US057693820
6/16/2020
6116=21
.EACH OCCURRENCE
$1.011. 00.000
AGGREGATE
$9,OOD,000
EXCESS LIAB
CLAIMS -MADE
DED I X I,. RETENTION$.. - -
._
$ .
....-..__.....'
C.
WORKERSCOMPENSAT*11 -
AND EMPLOYERS'UABJUTY
ANYPROPRIETORIPARTNER/EXECUTIVE YIN
OFFICERMtEMBEREXCLUDED? -
N/A�
Y
WBOE5678141942G-
6I762020 _.
611612021.
PER - O _
X STATUTE :ER
EL EACH ACCIDENT
$1,000,000
E.L. DISEASE.-. EAEMPLOYEE
$1,000,006
(Mandatory In NH)
Ifye's. describe under.
-
DESCRIPTION OF OPERATIONS below.
I
E.L. DISEASE= POLICY.LIMIT
$.1,000,000-
A
D-
'Employee :Benefits liability
.Professlon'I ability
Y
I
Y
B21A57693820
EONLAF112758374
6/16/2020
6/16/2020
6/16/2021
.6/161202i
Aggregate:Limft
Aggregate Limit
$4,o00,0o0
$1,000.000
DESCRIPTION OF opmwf6Ns i LOCATIONS I YEHICLES (ACORD 101, AddlRonal
Complete Named Insured for the Liability. Policy:
Remarks schedule, may: be attached R more speee is required)
Revenue Recovery Group, Inc. and King Woolf
DiscoveryAudit Services, LLC
Complete Named Insured for the Workers Compensation Policy:
Revenue Recovery Group, Inc.
Discovery Audit Services, LLC
See Attached...
City of Fort Collins
P.O. Box 580
Fort Collins CO 80522
USA
SHOULD. ANY OF THE ABOVEMESCRIBED POLICIES BE CANCELLED BEFORE
_
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
ACORD'25 (2016l03)
019882015 ACI
The ACORD na. a and logo are registered marks of ACORD
All
2• of 5. 4165
AGENCY CUSTOMER ID: REVEREC-02
LOC #:
ADDITIONAL REMARKS SCHEDULE Page 1 of 1
Arthur J. Gallagher Risk Management$ervices, Inc. I Revenue Recovery Group, Inc.
11637 Lake Sherwood Ave N'
POLICY NUMBER Baton Rouge LA 70816
CARRIER I I NAIL CODE
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE
nal Insured (Owners, Contractors or Lessors) -Blanket When Required by Written Contract - BP04020106
ercial Umbrella Endorsement
Transfer Rights of Recovery Against Others - CU64951207
Liability - 6i16t 020- 6/16i202i<
Insurance Company MPL200994820
i,000 Primary - Retention - $10,000 Aggregate
peaalty Insurance Binder
1,000 Excess
r Liability- Travelers Casualty and Surety Co. of America - Temn 6/16/2019 - 6/16/2020; Policy#106711867, Limit $2,000.000,'Single Loss Retention
of Fort Collins is included as additional insured with respects;to general liability and auto liability when required by written contract.
ACORD 101 (20D8101) ® 2008 A
The ACORD name and logo are registered marks of ACORD
All
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