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Home My WebLink AboutFMLASOURCE INC - INSURANCE CERTIFICATE (5)AillCOR" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 12/22/2on 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 PO Box 9017 135 Crossways Park Drive CONTACT NAME: PHONE 800 735 1588 AC No): 888-290-0302 E-MAIL ADDREss: request@sterlingrisk.com INSURERS AFFORDING COVERAGE NAIC # Woodbury NY 11797 INSURER A: Granite State Insurance Company 23809 INSURED FMLASource, Inc. 455 N.Cityfront Plaza Dr,13thF INSURERB: Lexington Insurance Company 19437 INsuRERc: The Hartford 914 Chicago IL 60611-5503 INSURER D : INSURER E : INSURER F : ^^%I=M A rcc f-=DTICIf-ATE NUMBER: 1529629432 REVISION NUMBER: 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 I LTR TYPE OF INSURANCE DL INqD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y 02LX00899647713 1/1/2018 1/1/2019 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR DAMAGE TOR NTED PREMISES Ea occurrence $1,000,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP/OP AGG $ 1,000,000 POLICY PRO LOC JECT A OTHER AUTOMOBILE LIABILITY 02CA0661436569 1/1/2018 1/1/2019 COMBINED SINGLE LIMIT Ea accident $ 1 000.000 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 $ A X UMBRELLA LIAR X OCCUR 29-UD-004067327-18 1/1/2018 1/1/2019 EACH OCCURRENCE $15,000,000 AGGREGATE $ 15.000,000 EXCESS LIAB CLAIMS -MADE DIED X I RETENTION $ 1 n roo WORKERS COMPENSATION X IPER STATUTE OERH $ C 12WEPK5818 1/1/2018 1/1/2019 E.L. EACH ACCIDENT $ 1,000.000 AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYEE $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 B Professional Liability Privacy & Network Sec Ins 02LX00899647713 06-181-32-73 1/1/2018 1/1/2018 1/1/2019 1/1/2019 Per Occurrence 1,000,000 Aggregate 3,000,000 Limit $3,000,000 Retro date 111/14 DESCRIPTION OF OPERATIONS I 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. CERTIFIGA 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 ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD