HomeMy WebLinkAbout567622 RSM US LLP - INSURANCE CERTIFICATE (8)�, ®
A� " CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDD/YYYY)
11/17/2016
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 endorsement(s).
PRODUCER
Marsh USA Inc.
2405 Grand Boulevard, #900
Kansas City, MO 64108
Attn: KansasCity.CertRequest@marsh.com Fax: 212-948-0015
CONTACT
NAME:
PHONE FAX
_WC No Exti; _. ____ WC, No):
E-MAILR
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A: Sentry Insurance A Mutual Company
24988
102813 REastm
INSURED RSM US LLP
One South Wacker Drive, Suite 800
INSURER B : Sentry Casualty Company
28460
INSURER C : Federal Insurance Company
20281
INSURER D :
Chicago, IL 60606
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: CHI-006058137-09 REVISION NUMBER:lu
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 ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
A
X
COMMERCIAL GENERAL LIABILITY
90-18524-04
11/30/2016
11/30/2017
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE a OCCUR
DAMAGE TO RENTED
PREMISES Eaoccunence
$ 1,000,000
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER.
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMPIOP AGG
$ 2,000,000
X POLICY ❑ PRO ❑ LOC
JECT
OTHER
A
AUTOMOBILE LIABILITY
90-18524-05 (AOS)
11130/2016
11/3012017
COMBINED SINGLE LIMIT
acciden
Ea t
$ 1,000,000
BODILY INJURY (Per person)
$
A
X ANY AUTO
90-18524-06 (MA)
11/30/2016
11/30/2017
BODILY INJURY (Per accident)
$
ALL OWNED SCHEDULED
AUTOS AUTOS
X X NON -OWNED
HIRED AUTOS AUTOS
PerOP RTY DAMAGE
$
$
C
X
UMBRELLA LIAB
X
OCCUR
936,1-18-93
11/3012016
11/30/2017
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 5,000,000
EXCESS LIAB
CLAIMS -MADE
DIED RETENTION $
$
A
WORKERS COMPENSATION
90-18524-01 (AOS)
11/30/2016
11/30/2017
X PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,000
B
AND EMPLOYERS' LIABILITY Y/ N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
N I A
90-18524-02 WI
( )
11/30/2016
11/30/2017
E.L. DISEASE - EA EMPLOYE
$ 1,000,000
E.L. DISEASE -POLICY LIMIT
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / 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 insured where required by written contract with respect to general and auto liabilities for
7516 Audit Services.
CERTIFICA It: HULUtK {iM 17liGLLM I IVI"
City of Fort Collins - Gerry Paul
215 N. Mason Street, 2nd Floor, PO Box 580
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
of Marsh USA Inc.
Keith A. Stiles oc r ,, _ :��
U Tyif B'LVT4 A�.VRU liVRrVRHI IV 17. MII l u lw ICJCIv6
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD