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HomeMy WebLinkAboutAPPLICATION SOFTWARE INC - INSURANCE CERTIFICATE (3)APPLI-1 OP ID: JC ACORO r ATE (MM/DD/YYYY) `,� CERTIFICATE OF LIABILITY INSURANCE TE(MM/ DIYY 017 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 endorsements . PRODUCER CONTANAME: CT Jessica Coleman _ The Insurance Group, Inc. P 1C 573-875-4800 Fvc No): 573-875-4514 200 East Southampton Drive c No Ext Columbia, MO 65203 ADDRESS; jcoleman@theinsurancegrp.com Charles W. Digges, Jr., CIC INSURERi51 AFFORDING COVERAGE NAIC # _ INSURER A: Executive Risk Indemnity 35181 INSURED Application Software, Inc _INSURER B:Travelers Propertyasualt Co 25674 John Riddick INSURER c : Executive Risk Indemnity 35181 P O Box 6044 Columbia, MO 65205 INSURER D : Federal Insurance Company_20281 INSURER E : _ INSURER F : I rd11MCIA11-GC (-PP'rIr_I 'nTF MI ii1ARF;P. r;FVlS!()N NLIMIRER- 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. POLICY EFF POLICY EXP INSR TYPE OF INSURANCE INSD WVD POLICY NUMBER LTR MM/DD/YYYY MM DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE T OCCUR X EPP 0134715 03/09/2016 01/01/2019 DAMEPREMISES S ( RENTED Ea occurrence $ 500,00 MED EXP (Any one person) $ 5,00 X EBL PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO JECT LOC PRODUCTS -COMP/OP AGG $ 2,000,000 Emp Ben. $ 1,000,000 OTHER: AUTOMOBILE LIABILITY COMBINEDccidentSINGLE LIMIT Ea a $ 1,000,000 BODILY INJURY (Per person) $ A ANY AUTO X IEBA 0134715 01/01/2017 01/01/2018 BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED X HIRED AUTOS X AUTOS PROPERTY DAMAGE Per accident $ X UMBRELLA LIAO X OCCUR EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 A EXCESS LIAB CLAIMS -MADE EPP 0134715 03/09/2016 01/01/2019 DED I X RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N 6JUB9981 M73615 10/11/2016 10/11/2017 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE E.L. DISEASE -POLICY LIMIT $ 1,000,00 $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH If yes, describe under DESCRIPTION OF OPERATIONS below N/A C Professional Liab 8224-7584 01/01/2017 01/01/2018 Occurence 5,000,000 D Cyber Liability �8225-9819 01/01/2017 01/01/2018 Aggregate 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Automatic Additional Insured on General Liability when required by written contract, but only to extent provided in policy form GA427. Designated Additional Insured on Auto Liability, but only to extent provided in policy form GA4004. CERTIFICATE HOLDER UANL rLLAI IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. Purchasing Department AUTHORIZED REPRESENTATIVE PO Box 580 Fort Collins, CO 80522 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD