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HomeMy WebLinkAbout474315 REVENUE RECOVERY GROUP INC - INSURANCE CERTIFICATE (21)A�COR" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) Fi/5/2018 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: Renee Meaux Arthur J. Gallagher Risk Management Services, Inc. PHONE 225 906 1271 FA'tfAIC 225-292-3893 235 Highlandia Drive, Suite 200 E-MAIL Baton Rouge LA 70810 ADORESS, renee_meaux@ajg.com INSURED Revenue Recovery Group, Inc. 12012 Bricksom Avenue Baton Rouge LA 70816 INSURER(S) AFFORDING COVERAGE NAIC N INSURERA:Travelers Casualty and Surety Company 19038 REVEREC-02 INSURERB:American Fire and Casualty Company 24066 INSURER c: Ohio Casualty Insurance Company 24074 INSURER D: Illinois Union Insurance Company 27960 rnVCDAr_rc rGDTIGIrATG NI IMRFD- 28797O56 RFVISICNU NI IMRFR- 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'- TYPE OF INSURANCE LTR . INSD WV POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDDNY LIMITS B X COMMERCIAL GENERAL LIABILITY Y N BZA57693820 1/10/2018 6/16/2018 EACH OCCURRENCE -DAMAGE $2,000,000 CLAIMS -MADE �X OCCUR TOENTED PREM E occurrence s50,000 MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 )( POLICY JECOT- LOC PRODUCTS - COMPIOP AGG $4,000,000 I $ OTHER: B AUTOMOBILE LIABILITY BZA57693820 1/10/2018 6/16/2018 LIMIT r(Eaaccdenq $1,000,000 ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED X AUTOS ONLY X AUTOS ONLY IMAGE (Per accident) $ $ C X UMBRELLA LIAB OCCUR N Y US057693820 1/10/2018 6/16/2018 EACH OCCURRENCE $1,000,000 nCLAIMS-MADE AGGREGATE EXCESS LIAB $1,000,000 DED X RETENTION $10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N UB365342 1/26/2018 6/16/2018 X STATUTE ETPERORH E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA E.L. DISEASE - EA EMPLOYEE -- $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 If Yes, describe under DESCRIPTION OF OPERATIONS below B D Employee Benefits Liability Professional Liability N N BZA57693820 EONLAF112758374 1/10/2018 6/6/2017 6116/2018 6/16/2018 Aggregate Limit 2,000,000 Aggregate Limit 3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Complete Named Insured for the Liability Policy: Revenue Recovery Group, Inc. and King Woolf Discovery Audit Services, LLC Complete Named Insured for the Workers Compensation Policy: Revenue Recovery Group, Inc. See Attached... CERTIFICATE HOLDER CANCELLATION City of Fort Collins Peg .Ogy streater P. Box 590 Fort Collins CO 80522 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 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: REVEREC-02 LOC #: ACORa 11111i� ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Arthur J. Gallagher Risk Management Services, Inc. NAMED INSURED Revenue Recovery Group, Inc. 12012 Bricksom Avenue Baton Rouge LA 70816 POLICY NUMBER CARRIER TNAICCODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Discovery Audit Services, LLC General Liability Endorsement: Additional Insured (Owners, Contractors or Lessors) - Blanket When Required by Written Contract - BP04020106 Commercial Umbrella Endorsement: Waiver Transfer Rights of Recovery Against Others - CU64951207 Cyber Liability - 7/12/17 - 6/6/2018: Policy Limit of Liability - $10,000,000 Each Claim or Event Rentention - $10,000 Aggregate ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD