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HomeMy WebLinkAbout551684 LION GROUP INC - INSURANCE CERTIFICATE (3)F -DATE ACCOR" CERTIFICATE OF LIABILITY INSURANCE 10/4/2016 M/ D/YYYY) lll`hTHIS 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: Arthur J. Gallagher Risk Management Services, Inc. PHONE 513-977-3152 Fax 1 W. 4th Street, Suite 1300 E-MANa IL Cincinnati OH 45202 INSURER(S) AFFORDING COVERAGE NAIC M INSURER A; The Travelers Indemnity Com an of 25682 INSURED INSURER B:Travelers Property Casualty Co of A 25674 Lion Group, Inc. INSURER C: First Specialty Insurance Cor orati 34916 7200 Poe Avenue INSURER D:Charter Oak Fire Insurance Com an 25615 Suite #400 — Dayton OH 45414 INSURER E : INSURER F : Crl1/FRAr:FC CFRTIFIrATF NI IMRFR• 107342720 RFVISInIY NLIMRFP- 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 I WV POLICY NUMBER POLICY EFF MM(DD/YYYY POLICY EXP MM(DDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY X� OCCUR 630-61-1469650 10/1/2016 10/1/2017 EACH OCCURRENCE $1,000,000 $300,000 -DWXCLAIMS-MADE PREMISGES EaEoccurrence) MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY 7 jE 0 LOC OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY X ANY AUTO ALLOSNED SCHEDULED X HIRED AUTOS X AUTOS NON -OWNED AUTOS 840-6H469650 10/1/2016 10/1/2017 UUMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ E accident Per accident $ 8 C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE IRE200013804 10/1/2016 10/1/2017 EACH OCCURRENCE $10,000,000 AGGREGATE $10,000,000 DED X RETENTION$0 $ D B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A UB-6H674368 UB - 6H715379 10/1/2016 10/1/2016 10/1/2017 10/1/2017 X STATUTE OERH E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYE $1,000,000 E.L. DISEASE- POLICY LIMIT 1 $1,0001000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) Work Comp Policy # UB-6H674368 covers all state except CA. Work Comp Policy #U3 - 6H715379 covers state of CA and Employers Liability for Ohio and Washington Agreement No. 7566 (Poudre Fire Authority Uniforms) The City of Fort Collins is included as additional insured for both General Liability and Automobile Liability as required by written contract. CER IIFICAI E HOLDER CANCELLA I ION The City of Fort Collins Purchasing Division 215 North Mason Street Second Fort Collins CO 80524 USA 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 C�' © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD