HomeMy WebLinkAbout474315 REVENUE RECOVERY GROUP INC - INSURANCE CERTIFICATE (12)ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MUMO/YYYY)
I 6/12i202O
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 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 policy(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 confei rights to the certificate.holder in-neu of such ;endorsement(s).__
PRODUCER - - - - NME Renee Meaux
Arthur J. Gallagher Risk Management Services, Inc. MoNE' 225-906 1271 FAX Rc ; 225-292-3893
235 Highlandia Drive, Suite 200 No-
E-MAIL
___... _-
Baton Rouge LA 70810 ADDRESS: reneerneau)(Oaig.com
INSURED
Revenue Recovery Group, Inc.
11637 Lake Sherwood Ave N
Baton Rouge LA 70816
A: American Fire and Casualty Company
B': Ohio Casualty Insurance Company
c: Travelers. Casualty and Surety Company
o : Illinois Union Insurance Comoanv
COVFRAGFR CFRTIFICATF hit 11ACCR•.Af»AAAAOA omnalew siriuoco.
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
CERTIMATE 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. UMITS;SHOWN
MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
TYPEOF INSURANCE
A L
I O
SUB
WYD
.POLICY
NUMBER
POLICY EFF -
'MMIDDIYY.
POLICY EXP
I MIDD/YY
LIMITS
q
X
COM_MERCIALGENERALLIABILITY
Y
Y
137A57693B20
6/16/2020
6/16/2021
EACH OCCURRENCE
$2.600.600
DAMAGE TO RFATEff-_
CLAIMS -MADE OCCUR
PREMISESEaoccurrence
$nxo
MED EXP (Any oneperson)
$ 5,000
PERSONAL &ADV.INJURY
$
GENL AGGREGATE LIMIT APPLIES PER:
7%� POLICY P.
❑. JECT LOC
'GENERAL AGGREGATE
$4,000,000
l
PRODUCTS -COMP/oPAGG
84,000,000
$
17 OTHER:
A
AUTOMOBILELU161tJTY
Y
Y
BZA57693820.
-
6/18/2020
6/182021
COMBINEDSINGLE.LIMIT
Ea. accident).
$1:D00,000
BODILY INJURY (Per em6n).
I $
ANY AUTO
-
OWNED
AUTOS SCHEDULED
ONLY AUTOS.
t)
BODILY INJURY (Per accidenHIRED
$
X
i
I AUTOS ONLY X AUTOS ONLY
PeOaPodR'ZDAMAGI .
$ _
_..I
$.
�B
X
UMBRELLAUAB X B
OCCUR
Y
I Y
93
USO576820
6/16/2020
6/16/2021
EACH OCCURRENCE ..
$1.000,000 . .
EXCESS LIA9 (CLAIMS -MADE
AGGREGATE
$1,000,000
DED I X I RETENTION$.1 - -
.. _.... . _.. _. .__ ..
$.
_
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETOFL'PARTNEPJEXECUTIVE
OFFICERIMEMBEREXCLUDED?
NIA
Y
UBOL5678
41942G
6116/2020
61162021
X STATUTE
H-
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE - EA EMPLOYEE
$1,000,000
.
(Mandatory In NH)
II yyes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE —POLICY LIMIT
$1.ODO,000
A
D
Employee Benefits Uabilay
Pmiessional LiaNlity
Y
Y
;BZA57893820
EONLAF112758374
6I162MO
6/16/2020 I
J
6/162021
6/162021
Aggregate Limit
Aggregate Lima
S4,DOO,000
$1,000,000
RevenuDESCRIe Recoveryrnei Group, ON OF-6PERATIONS /oLOCATIONS tot, Additional
thand King (Woo Woolf
Re mrks Schedule, may be attached H more apace Is requtred)
Discovery Audit Services, LLC
Complete Named lnsured.for the Workers Compensation. Policy:
Revenue Recovery Croup, 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
City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS.
P.O. Box 580
Fort Collins CO 80522 AumoRizEDREPREsERTATrve
USA
i.
01988-2015 ACORD CORPORATION. All rights reserve
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
4• 0f 5 4165
AGENCY CUSTOMER ID: REVEREC•02
LOC #:
ACCWE) ADDITIONAL REMARKS SCHEDULE
Page 1 of 1
AGENCY - -
Arthur J. Gallagher Risk Management Services, Inc.
NAMED INSURED
Revenue Recovery Group, Inc.
11637 Lake Sherwood Ave N
Baton Rouge LA 70816
.
voucY NUMBER
CARRIER
NAIgCODE
EFFECTIVE.DATE:
.ALM I1UNAL MtMAMb ... _,
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER:. 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE
General Liability.Endorsement:
Additional Insured (Owners, Contractors or Lessors) - Blanket When Required by Written Contract - BP04020106
Commercial Umbrella Endorsement:
Waiver Transfer Rights of Recovery Against Others _ CLI6495120
Cyber Liability - 6/16/2020 - 6/1612021:
Hisoox Insurance Company MPL200994820
$5,000,000 Primary - Retention - $10,000 Aggregate
HSB Specialty Insurance Binder
$5,000,000 Excess
Fidelity Liability - Travelers Casualty and Surety Co. of America - Term 6/16/2019 - 6/1612020; Policy#106711867, Limit $2;000,000; Single Loss Retention
$50,000
101 (2008101) 0 2008 AC
The ACORD parr and logo are registered marks of ACORD
5*ofs 4165