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HomeMy WebLinkAboutAFLAC INCORPORATED - INSURANCE CERTIFICATE (3)Client#: 103008 30AFLACINCOR ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDf YYYY) MlDD/ 5/14/2015 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 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(s). PRODUCER CONTACT NAME: J Smith Lanier & Co. Columbus aHcN Ext : 706 324-6671 FAX No): 706 576-5607 200 Brookstone Centre Parkway E-MAIL Suite 118 ADDRESS: INSURERS) AFFORDING COVERAGE NAIC # Columbus, GA 31904 INSURER A: Great Northern Ins A++ XV 20303 INSURED INSURER B : Federal Insurance A++ XV 20281 Aflac Incorporated INSURER C : Pacific Indemnity Co A++ XV - 20346 Attn: Mr. Nelson Phillips 1932 Wynnton Road INSURER D : Columbus, GA 31999 INSURERE: INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUB WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FXOCCUR 35960492 5/16/2015 05/16/2016 EACH OCCURRENCE $1 000 000 PREMISES ERENTED nce $1 000 000 MED EXP (Any one person) $10 000 PERSONAL & ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY I X1 ECOT LOC OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OPAGG $2,000,000 Gen Agg Ca $40,000,000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS 73580109 5/16/2015 05/16/201 COMBINED Ea aidentSINGLE LIMIT cc $ 1 ,000, 000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 79825301 5/16/2015 05116/2016 EACH OCCURRENCE s25,000,000 AGGREGATE s25,000,000 DED I I RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITYUTE ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 71716058 5/16/2015 05/16/201 X PER OTH- E.L. EACH ACCIDENT $5OO 000 E.L. DISEASE - EA EMPLOYEE $500 000 E.L. DISEASE - POLICY LIMIT s500,000 DESCRIPTION OF OPERATIONS / LOCATIONS ! VEHICLES (;CORD 101, Additional Remarks Schedule, may be attached if more space is required) *Aflac's independent insurance agents are not employees of Aflac and are not covered by this Certificate of Insurance* 11J911ls13:1 City of Fort Collins 215 North Mason, 2nd Floor Fort Collins, CO 80524-0000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1998-7014 ACORD CORPORATION. All rights reserved ACORD 25 (2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD #S2644021/M2643895 CWW