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HomeMy WebLinkAboutAPPLICATION SOFTWARE INC - INSURANCE CERTIFICATE (4),4c R CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 11/23/2016 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 CONTACT NAME. THE INSURANCE GROUP INC PHONE FA 200 EAST SOUTHAMPTON DRIVE (AIC, No, Ext): (AIX,No): E-MAIL ADDRESS: COLUMBIA MO 65203 INSURER(S) AFFORDING COVERAGE NAIC # 254SC INSURER TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA INSURED INSURER B. APPLICATION SOFTWARE INC & C/O JOHN RIDDICK INSURER PO BOX 6044 INSURER D 1 INSURER COLUMBIA MO 65205 INSURER F. COVERAGES CERTIFICATE NUMBER: 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MM/DDIYYYY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any oneperson) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE POLICY LIMIT APPLIES PER: PROJECT LOC PRODUCTS — COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO SCHSFDULED ALL OWNED NON -OWNED AUTOS AUTOS HIRED AUTOS COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY Per person)$ BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB EXCESS LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE S AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Y/N (Mandatory in NH) N If yes, describe under DESCRIPTION OF OPERATIONS below N/A (6JUB-9981 M73-6- 16) 10- 1 1 - 16 10- 1 1 - 1 7 X WC ST ITU- TORY LIMITS ETH- 10 ER E.L. EACH ACCIDENT $ 1,000,000 E.L.DISEASE — EA EMPLOYEE $ 1,000,000 E.L. DISEASE —POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION CITY OF FORT COLLINS PURCHASING DEPARTMENT PO BOX 580 FORT COLLINS CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREFO, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE — A JLx,.e_ _ ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010/06) The ACORD name and logo are registered marks of ACORD