HomeMy WebLinkAbout549111 COMPSYCH CORPORATION - INSURANCE CERTIFICATE (4)A� L? CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
12/22/2017
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
Van Wagner Agency
135 Crossways Park Drive
PO Box 9017
T
800 735 1588 a/c Noy 888-290-0302
FAbMDRLEss:re uest sterlin risk.com
INSURERS AFFORDING COVERAGE
NAIC #
Woodbury NY 11797
INSURER A: Granite State Insurance Company
23809
INSURED
Compsych Corporation
455 N.Cityfront Plaza Dr, 13thF
INSURER B : The Hartford
914
INSURER C
Chicago IL 60611-5503
INSURERD:
INSURER E :
INSURER F :
rnvoDAnDc CERTIFICATE NUMBER: 979296493 REVISION NUMBER:
vv
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
SUBR
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MM/DD/YYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
Y
Y
02LX00899647713
1/l/2018
1/1/2019
EACH OCCURRENCE
$ 1.000.000
7
X
CLAIMS -MADE OCCUR
MAGE TO RENTED
PREMISES (Ea occurrence)
$1,000,000
X
MED EXP (Any one person)
$ 5,000
Abuse/Molestatio
PERSONAL & ADV INJURY
$1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 3,000,000
PRODUCTS - COMP/OP AGG
$ 1,000.000
A
POLICY PRO a LOC
JECT
OTHER:
AUTOMOBILE LIABILITY
Y
Y
02CA0661436569
1/1/2018
1/1/2019
Deductible
COMBINED SINGLE LIMIT
Ea accident
$ 0
$
1000 OQQ
BODILY INJURY (Per person)
$
ANY AUTO
BODILY INJURY (Per accident)
$
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
X HIRED AUTOS X AUTOS
PROPERTY DAMAGE
Per accident)$
$
Deductible
0
A
X
UMBRELLA LIAB
X
OCCUR
Y
29-UD-004067327-18
1/1/2018
1/1/2019
EACH OCCURRENCE
$ 15,000.000
AGGREGATE
$ 15,000,000
EXCESS LIAB
CLAIMS -MADE
DIED RETENTION $
WORKERS COMPENSATION
X I STATUTE OERH
$
g
Y
12WEPK5818
1/1/2018
1/1/2019
E.L. EACH ACCIDENT
$ 1,000,000
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. DISEASE - EA EMPLOYE
$ 1,000,000
OFFICER/MEMBER EXCLUDED? ❑
(Mandatory in NH)
N / A
E.L. DISEASE -POLICY LIMIT
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
A
Professional Liability
02LX00899647713
1/1/2018
1/1/2019
Per Occurence 1,000,000
Aggregate 3,000.000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
The City of Fort Collins, its officers, agents and employees are included as additional insureds as respect to General Liability as per endorsement form CG2026
and as respect to Auto Liability as per endorsement form 90812 (1-14) to the extent provided therein.
GERTI
City of Fort Collins
215 N. Mason Street
2nd Floor
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
. La.. ..A
\J 1'00-4V .y..... ......... �.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD