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HomeMy WebLinkAbout113272 VISION SERVICE PLAN (VSP) - INSURANCE CERTIFICATE (2)A�RD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 0/01/2015 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 Aon Risk Insurance Services West, Inc. Sacramento CA Office CONTACT NAME: (AJCO. No. Ext): (916) 369-4800 aC No ); 847-953-2283 E-MAIL ADDRESS: 2277 Fair Oaks Blvd, Suite 250 Sacramento CA 95825 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: National union Fire Ins Co of Pittsburgh 19445 vision Service Plan INSURER B: Safety National Casualty Corp 15105 3333 Quality Drive Rancho Cordova CA 95670-9757 USA INSURER C: INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 570059693631 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. Limits shown are as requested LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYYY MMlDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X❑ OCCUR GL General Liability EACH OCCURRENCE $1, 000, 000 PREMISES Ea occurrence $1,000,000 MED EXP (Any one person) $10, 000 PERSONAL & ADV INJURY $1, 000, 000 GENT AGGREGATE LIMIT APPLIES PER: POLICY ❑ PET ❑ LOC OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG S2,000,000 SIR/Deductible $2 S , 000 A AUTOMOBILE LIABILITY X ANY AUTO X ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS cA7030267 Business Auto Liability 11/01/2014 11/01/201S COMBINED SINGLE LIMIT Ea accident $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 B ^WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/ PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A LDM4049682 Workers' Comp. 10/01 2015 10, O1 72016 X PER CTH- 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 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The workers' comp. deductible is $250,000 Certficate holder is additional insured as respects auto liability and gene liability CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins AUTHORIZED REPRESENTATIVE Po Box 580 Ft Collins Co 80522 USA n �nacctanc� ctafrG� �t� na rh ra rn 0) 0 0 O Z r Iq U w 1= N U ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The !!CORD name and logo arc registered marks of ACORD AGENCY CUSTOMER ID: 570000055831 LOC #: 'A ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk Insurance Services West, Inc. NAMED INSURED vision Service Plan POLICY NUMBER See certificate Number: 570059693631 CARRIER See certificate Number: 570059693631 NAIC CODE EFFECTIVE DAIE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Additional Named Insured: Marchon Eyewear, Inc. Marchon Eyewear, Inc. its subsidiaries, Monkey Software Pty. Ltd. (Australia) Marchon Canada Marchon UK Ltd. officeMate software Solutions, Inc. Allure Eyewear, LLC Altair Eyewear, Inc. Dragon Alliance affiliates & divisions The ACORD name and logo are registered marks of ACURD