HomeMy WebLinkAbout416522 KROLL FACTUAL DATA - INSURANCE CERTIFICATE (5)1 ® 70529/2015
(MM1DD/YYYY)
A� O�RD CERTIFICATE 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 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:
MARSH USA INC.
1050 CONNECTICUT AVENUE, SUITE 700 LAIC, No. Ext1 Nc No):
WASHINGTON, DC 20036-5386 E-MAIL
Annaccc
999584-KROLL-6/1-15-16
INSURED
Kroll Factual Data
5200 Hahns Peak Dr
Loveland, CO 80538
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INSURER(S) AFFORDING COVERAGE
NAIC 0
INSURER A: QBE Insurance Corporation
39217
INSURER B : NIA
NIA
INSURER C : N/A
N/A
INSURER D: Stonington Insurance Company
10340
INSURER E : N/A
N/A
INSURER F : N/A
N/A
CLE-004371385-15 REVISION NUMBER-8
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.
--
I -
INSR
LTR
TYPE OF INSURANCE
ADDL
SUBR
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MM/DD/YYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE M OCCUR
CGA3977091
06/01/2015
06/01/2016
EACH OCCURRENCE
$ 1,000,000
PREM SES� a o'currence
$ 100,000
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
GENT AGGREGATE LIMIT APPLIES PER:
X POLICY F_-1 PRO JECT D LOC
OTHER:
GENERAL AGGREGATE
$ 2.000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
A
AUTOMOBILE LIABILITY
X ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIRED AUTOS AUTOS
CBA3977092
06/01/2015
06/01/2016
COMBINED SINGLE LIMIT Ea ccident
a
$ 1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
UMBRELLA LIAR
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE _
$
AGGREGATE
$
DED RETENTION $
$
D
D
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE Y
(MandatoryOFFICERIMm H) EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
A
NIA
CWC3977088 (ADS)
CWC3977089 WI
( )
CWC3977090 AZ GA FL TX
( )
06/01/2015
06/01/2015
06/01/2015
06/01/2016
06/01/2016
06/01/2016
X PER oTH-
STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L- DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
The City of Fort Collins is included as an Additional Insured as required by written contract, but limited to the operations of the insured under said contract, with respect to both the Commercial General Liability and
Automobile Liability policies.
GLK 1 IFIGA I t HULUtK liAlY I,CLLH I IV17
The City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Ann: City's Director of Purchasing & THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Risk Management ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 580
Fort Collins, CO 80522
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Manashi Mukherjee
U 1988-2014 AGOKU GUKPUKA I IUN. All rlgnts reserves.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD