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HomeMy WebLinkAbout474315 REVENUE RECOVERY GROUP INC - INSURANCE CERTIFICATE (18)AC� ® DATE (MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE Fi/5/2018 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 endorsements . PRODUCER CONTACT lV _ Arthur J. Gallagher Risk Management Services, Inc. PHONE . 2NAME: Renee Meaux ux FAX 225 292 3893 235 Highlandia Drive, Suite 200 E-MAIL Baton Rouge LA 70810 . renee_meaux@)ajg.com Jg INSURERS) AFFORDING COVERAGE NAIC N INSURER A: Travelers Casualty and Surety Company 19038 INSURED REVEREC-02 INSURER B: American Fire and Casualty Company 24066 Revenue Recovery Group, Inc. INSURER c: Ohio Casualty Insurance Company 24074 12012 Bricksom Avenue INSURER D:Illinois Union Insurance Company 27960 Baton Rouge LA 70816 INSURER E : rn%1FDOr.FC CFDTIFICOTF IUI IMRFD• R54R9312n DG1/ICIfIIU IUI IMRFD- 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 INSD WV POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY Y N BZA57693820 1/10/2018 6/16/2018 EACH OCCURRENCE $2,000,000 CLAIMS -MADE X� OCCUR �RTEO PREMISES Ea occurrence E50,000 MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $ GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X li POLICY PE� LOC PRODUCTS - COMP/OP AGG $4,000,000 $ OTHER: B AUTOMOBILE LIABILITY BZA57693820 1/10/2018 6/16(2018 OMMM SINGLE LIMIT accident $1,000,000 BODILY INJURY (Per person) E ANY AUTO OWNED SCHEDULED _ AUTOS ONLY AUTOS HIRED NONOWNEDA X AUTOS ONLY X AUTOS ONLY BODILY INJURY (Per accident) E Per accident $ _ C X UMBRELLA LAB X OCCUR N Y US057693820 1/10/2018 6/16/2018 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 EXCESS LIAB CLAIMS -MADE DED I X i RETENTION $10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N/A N UB365342 1/26/2018 6116/2018 X I STATUTE ORH E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 B D Employee Benefits Liability Professional Liability N N BZA57693820 EONLAF112758374 1/10/2018 6/6/2017 6/16/2018 6/16/2018 Aggregate Limit 2,000,000 Aggregate Limit 3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Complete Named Insured for the Liability Policy: Revenue Recovery Group, Inc. and King Woolf Discovery Audit Services, LLC Complete Named Insured for the Workers Compensation Policy: Revenue Recovery Group, Inc. See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE James O'Neill Purchasing THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 580 Fort Collins CO 80522 USA AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: REVEREC-02 LOC #: AFRO ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Arthur J. Gallagher Risk Management Services, Inc. NAMED INSURED Revenue Recovery Group, Inc. 12012 Bricksom Avenue Baton Rouge LA 70816 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Discovery Audit Services, LLC General Liability Endorsement: Additional Insured (Owners, Contractors or Lessors) - Blanket When Required by Written Contract - BP04020106 Commercial Umbrella Endorsement: Waiver Transfer Rights of Recovery Against Others - CU64951207 Cyber Liability - 7/12117 - 6/6/2018: Policy Limit of Liability - $10,000,000 Each Claim or Event Rentention - $10,000 Aggregate ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD