HomeMy WebLinkAboutRUBINBROWN LLP - INSURANCE CERTIFICATE (2)AcoRhi' CERTIFICATE OF LIABILITY INSURANCE
16.1 1 1 / 16/2016
DATE(MM/DD/YYYY)
1 1 /3 /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 Lockton Companies
TCT
NAME:
Three City Place Drive, Suite 900
St. Louis MO 63141-7081
(314) 432-0500
PHONE
/C, No, Ext : A/C, No):
E-MAIL
ADDRESS:
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A: The Continental Insurance Company
35289
INSURED Rubin Brown, LLP
INSURER B : Valley Fore Insurance Company
20�08
1387500 One North Brentwood Boulevard
St. Louis MO 63105
INSURER C
INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: 1371 1286 REVISION NUMBER: XXXXXXX
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
INSD
SUBR
WVD
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MM/DD/YYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
N
N
5085581252
11/16/2015
11/16/2016
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE 1 OCCUR
DAMAGE TO RENTED
PREMISES Ea occurrence)$
500,000
MED EXP (Any oneperson)
15,000
PERSONAL & ADV INJURY
$ 1 .000,000
GEN'L AGGREGATE LIMIT APPLIES PER.
POLICY JERCOT LOC
GENERAL AGGREGATE
$ 2.000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
OTHER
AUTOMOBILE
LIABILITY
ANY AUTO
NOT APPLICABLE
COBINEDaccidentSINGLE LIMIT
$XXXXXXX
BODILY INJURY (Per erson
person)
$ XXXXXXX
AUTOWNED SCHEDAUTOS
BODILY BODILY INJURY (Per accident
$ XXXXXXX
PROPERTY DAMAGE
Per accidents
$XXXXXXX
NON -OWNED
HIRED AUTOS AUTOS
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$ XXXXXXX
EXCESS LIAB
CLAIMS -MADE
NOT APPLICABLE
AGGREGATE
$ XXXXXXX
DED RETENTION $
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE a
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA A
N
4013789960
1 1 /16/2015
11/16/2016
OTH-
X I STATUTE FIR
E.L. EACH ACCIDENT
$ 1 ,000,OOO
E.L. DISEASE - EA EMPLOYEE
$ I ,000,000
E.L. DISEASE - POLICY LIMIT
It I ,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
A THIRTY (30) DAY NOTICE OF CANCELLATION FOR GENERAL LIABILITY COVERAGE WILL BE PROVIDED FOR REASONS OTHER THAN
NON-PAYMENT OF PREMIUM.
CERTIFICATE HOLDER CANCELLATION
13711286
CITY OF FORT COLLINS PURCHASING
FINANCIAL SERVICES
PURCHASING DIVISION
215 N. MASON ST. 2ND FLOOR
PO BOX 580
FORT COLLINS, CO 80522
ACORD 2512014101)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
REPRESENTATIVE
-00
cc) 19RR- CORD CO
All rinhtc recPrverl
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