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HomeMy WebLinkAboutAPPLICATION SOFTWARE INC - INSURANCE CERTIFICATE (5)ACOR�� CERTIFICATE OF LIABILITY INSURANCE DATE (MM1DD/YYW) 12/28/2017 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 endorsements . PRODUCER CONTACT NAME: TIG ADVISORS PHONE FAX 200 EAST SOUTHAMPTON DRIVE (A/C, No, Ext): (A/C, No): E-MAIL ADDRESS: COLUMBIA MO 65203 254SC INSURER(S) AFFORDING COVERAGE NAIC # INSURER A TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA 561110 INSURED INSURER B. APPLICATION SOFTWARE INC & INSURERC: PO BOX G044 COLUMBIA MO 65205 INSURERD. INSURER E: 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 INSD SUER WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any oneperson)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER. POLICY❑ PROJECT ❑ LOC GENERAL AGGREGATE $ PRODUCTS — COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS SCHEDULED ONLY AUTOS HIRED AUTOS NON -OWNED ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea accident) $ BODILY INJURY Perperson) $ BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ DED RETENTION $ A JWORKERS 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 NIA N (GJUB-998 1 M73-6- 1 7) 1 O- 11 - 17 1 O- 11 - 18 X PER STATUTE FH- I 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 OPERATIONSILOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE CITY OF FORT COLLINS POLICYPROVISIONS. PRUCHASING DEPARTMENT PO BOX 580 AUTHORIZED REPRESENTATIVE FORT COLLINS CO 80522 LLI ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD