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HomeMy WebLinkAbout584342 MGT OF AMERICAL CONSULTING LLC - INSURANCE CERTIFICATESHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME: CONTACT (A/C, No): FAX E-MAIL ADDRESS: PRODUCER (A/C, No, Ext): PHONE INSURED COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ PROPERTY DAMAGE $ BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOS ONLY AUTOS NON-OWNED OWNED SCHEDULED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? Preview Preview Preview (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT ER OTH- STATUTE PER (MM/DD/YYYY) LIMITS POLICY EXP (MM/DD/YYYY) POLICY EFF LTR TYPE OF INSURANCE POLICY NUMBER INSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB EACH OCCURRENCE $ AGGREGATE $ $ OCCUR CLAIMS-MADE DED RETENTION $ PRODUCTS - COMP/OP AGG $ GENERAL AGGREGATE $ PERSONAL & ADV INJURY $ MED EXP (Any one person) $ EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 6/29/2018 Earl Bacon Agency, Inc. P.O. Box 12039 Tallahassee FL 32317 Bobby Bacon/Erin Dennard 850-878-2121 850-878-2128 bbacon@earlbacon.com/edennard@earlbacon.com Continental Casualty Company 20443 MGTOF-1 Valley Forge Insurance Company 20508 MGT of America, LLC MGT of America Consulting, LLC 4320 W. Kennedy Blvd. Tampa FL 33609 American Casualty Company of Reading, PA 20427 Transportation Insurance Company 20494 Travelers Casualty & Surety Company of America 31194 123605209 C X 1,000,000 X 300,000 X A-XV Rating 15,000 1,000,000 2,000,000 X Y Y 5095130327 7/1/2018 7/1/2019 2,000,000 Deductible None C 1,000,000 X X X A-XV Rating Y Y 2093563501 7/1/2018 7/1/2019 Deductible None A X X 5,000,000 X 2093563496 7/1/2018 7/1/2019 5,000,000 X 10,000 B D Y WC311086712 - All Other WC311086788 - CA 7/1/2018 7/1/2018 7/1/2019 7/1/2019 500,000 500,000 500,000 E Professional Liability (E&O) Claims-Made Form 7/5/95 Retro Date/A++XV N N 105638880 7/1/2018 7/1/2019 Each Claim Aggregate 2,500,000 5,000,000 Umbrella: A-XV Rating. All Other Workers' Comp & CA Workers' Comp: A-XV Rating. CA - Workers' Comp Employers Liability Limits: $1,000,000 Each Accident $1,000,000 Disease Policy Limit $1,000,000 Disease Each Employee Cyber Liability: Continental Casualty Company -Limits of Liability $1,000,000/$1,000,000 Retention $10,000 Reto Date 3/30/2017-Claims Made Effective 3/30/18 - 3/30/2019 City of Fort Collins P.O. Box 580 Fort Collins CO 80522