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ACERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
06/ 07/2018
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 confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
CONTACT
NAME:
PHONE 1-877-945-7378 FAX 1-888-467-2378
xt: A/C No:
Willis Insurance Services of Georgia, Inc.
c/o 26 Century Blvd
P.O. Box 305191
E-MAIL
ADDRESS: certificates@willis.com
INSURERS AFFORDING COVERAGE
NAIC#
Nashville, IN 372305191 USA
INSURER A: Phoenix Insurance Company
25623
INSURED
INSURERB: Charter Oak Fire Insurance Company
25615
INSURER C: Travelers Indemnity Company of America
25666
Global Payments Inc.
Three Alliance Center
3550 Lenox Road NE, Suite 3000
INSURER D:
INSURER E
Atlanta, GA 30326
INSURER F :
I
i.cM-1^AT� AUIRADCD. W644547A RFVIQlr)M NIIMRFR-
vTHIS 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
SUBR
POLICY NUMBER
POLICY EFF
/Y
MM/DDYY
POLICY EXP
MM/DD/YYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE I OCCUR
DAMAGE TO RENTED
PREMISES Ea occurrence)$
1,000,000
MED EXP (Any one person)
$ 10,000
A
Y
HNGLSA-158D7542-18
06/01/2018
06/01/2019
PERSONAL & ADV INJURY
$ 1,000,000
GEN'LAGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OPAGG
$ 2,000,000
POLICY PRO LOC
JECT
OTHER:
AUTOMOBILE LIABILITY
ECOMe acccidentSINGLE LIMIT
$ 2,000,000
BODILY INJURY (Per person)
$
X ANY AUTO
BODILY INJURY (Per accident)
$
g
OWNED - SCHEDULED
AUTOS ONLY AUTOS
Y
HOCAP-158D7566-18
06/01/2018
06/01/2019
PROPERTY DAMAGE
Per accident
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DED RETENTION $
$
WORKERS COMPENSATION
X PER OTH-
STATUTE ER
C
AND EMPLOYERS' LIABILITY Y/N
ANYPROPRIETOR/PARTNER/EXECUTIVE ❑
(OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
N/A
HC2NUB-23337415-18
06/Ol/2018
06/01/2019
E.L. EACH ACCIDENT
1,000,000
$
E.L. DISEASE - EA EMPLOYEE
1,000,000
$
E.L. DISEASE - POLICY LIMIT
$ 1, 000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
B Workers' Compensation
HROUB-IISD8912-18
06/01/2018
06/01/2019
Each Accident
$1, 000, 000
Per Statute
Disease -Policy Limit
$1, 000, 000
'.
.Disease -Each Employe
$1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
City of Fort Collins is included as an Additional Insured as respects to General Liability and Auto Liability as per
written contract.
CERTIFICAI h HULUtH NMIY< GLLM I IVn
City of Fort Collins
Purchasing Division
P.O. Box 580
Fort Collins, CO 80522
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
V
V I`Joo-LU I Al.VrtU %�%Jnr %JnM I IVIN. M I IU Ra Icacl vcu.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
SR ID: 16265591 BATCH: 740619