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HomeMy WebLinkAboutBCN ADVANTAGES INC - INSURANCE CERTIFICATE (2)155935 A�OR D0 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYYj 2/28/202s/2o1s 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 Commercial Lines - (248) 353-5800 USI Insurance Services National, Inc. CONTACT NAME: USI Insurance Services National, Inc. PHONE 248.353.5800 FAX 610.537.2371 A/C No EXt : A/C No E-MAIL ADDRESS: 4000 Town Center, Suite 800 INSURER(S) AFFORDING COVERAGE NAIC # Southfield, MI 48075 INSURER A: Amerisure Insurance Company 19488 INSURED INSURERB: Amerisure Mutual Insurance Co. 23396 BCN Advantages, Inc. INSURERC: 3650 W. Liberty INSURER D INSURER E : Ann Arbor, MI 48103 INSURER F : COVERAGES CERTIFICATE NUMBER: 12786109 REVISION NUMBER: See below 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 MMIDD/YYYY POLICY EXP MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 CLAIMS -MADE OCCUR DAMAGE TORENTED PREMISES Ea occurrence _ $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ _ GEN'L GENERAL AGGREGATE AGGREGATE LIMIT APPLIES PER: $ POLICY JE C LOC JECT PRODUCTS - COMPIOP AGG $ S OTHER: AUTOMOBILE LIABILITY (CO, SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ $ A X UMBRELLA LIAB X OCCUR CU2067648 03/01/2018 03/01/19 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 EXCESS LIAB CLAIMS -MADE DED I I RETENTION$ $ COMPENSATION WORKERB AND EMPLOYERS' AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N X WC 2085634 12/01/2017 12/1/2018 X STATUTE EERPER H E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) NIA E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ soo,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Alternate Employer Endorsement in favor of Cre8Play, Inc. Waiver of Subrogation when required by written contract and where permitted by law; applies in favor of the certificate holder, regarding the insured's workers' compensation policy GtK I II-lUA 1 t HULUtK GANGtLLA I IUN City Of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O. BOX 580 ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE n The ACORD name and logo are registered marks of ACORD ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD ,,,'°""" 11111111111111111111111111111111111 IN 11111111111111111111111111111111111111111111111111111 ..33A8_10940..000