Loading...
HomeMy WebLinkAbout113272 VISION SERVICE PLAN - INSURANCE CERTIFICATE (3)ACORD' CERTIFICATE OF LIABILITY INSURANCE 11111I 10/ t /2017 F DATE(MMIDDIYYYY) 1 10/ 12/2016 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 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 endorsement(s). PRODUCER Lockton Insurance Brokers, LLC 725 S. Figueroa Street, 35th A. CA License #OF15767 Los Angeles CA 90017 (213) 689-0065 CONTACT tINE, a No, Ext : Fv , No): E-MAIL ADDRESS: INSURER AFFORDING VERA E NAI INSURER A: National Union Fire Ins Co Pitts. PA 19445 INSURED Vision Service Plan 1415962 3333 Quality Dr. Rancho Cordova CA 95670-9757 INSURER B : Safety National Casualty Corporation 15105 INSURER C INSURER D : INSURER E INSURER F COVERAGES V1SSF.01 CERTIFICATE NUMRER- 1410?791 RFVISION NIIMRFR• XXXXXXX 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. NS LTR TYPE OF INSURANCE ADDL INSD SUER WVD POLICY NUMBER POLICY EFF MM DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR SIR/Ded. $25.000 Y N GL2404429 1 UI/2016 11/1/2017 EACH OCCURRENCE 1,000,000 PREMISES OEa oNcur ence 1,000,000 X MED EXP (Any oneperson) 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY SEC LOC OTHER: GENERAL AGGREGATE $ 2,000.000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO OWNED UAAUTOSONLY AUTOS UNON-OWNED ONLY AOV Ded Y N CA2305070 I1/1/2016 I1/l/2017 Eo ao"0.1D SINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ XXXXXXX BODILY INJURY (Per accident $ XXXXXXXSULED PROPERTY DAMAGE ide $ XXXXXXXXComp. XX Coll. Ded $ 3,000 UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX AGGREGATE $ XXXXXXX DED I I RETENTION $ $ B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? N❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA` N LDM4049682 (AOS) PS4049683(WI) 10/1/2016 10/1/2016 10/1/2017 1U/1/ZVI/ PER OTH- X STATUTE ER E.L. EACH ACCIDENT $ I OOO,OOO E.L. DISEASE -EA EMPLOYEE 1,000,000 lE.L. DISEASE - POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins are Additional Insured to the extent provided by the policy language or endorsement issued or approved by the insurance carrier. UtK I II-IUA I t HULUtK GANUtLLA I IUN Jee Attactiment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 14362791 AUTHORIZED REPRESENTATIVE City of Fort Collins PO Box 580 Ft Collins CO 80522 ACORD 25 (2016/03) ©1 088-204-ACORD C RPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD Vision Service Plan, et al Named Insured Schedule Marchon Eyewear, Inc. Marchon Eyewear, Inc. its subsidiaries, affiliates & divisions Monkey Software Pty. Ltd. (Australia) Marchon Canada Marchon UK Ltd. OfficeMate Software Solutions, Inc. Allure Eyewear, LLC Altair Eyewear, Inc. Dragon Alliance Attachment Code: D522140 Master ID: 1415962, Certificate ID: 14362791