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HomeMy WebLinkAboutAPPLICATION SOFTWARE INC - INSURANCE CERTIFICATE (6)APPLSOF-01 LFRANKE ACLl�1 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 01/02/2018 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 endorsement(s). PRODUCER TIG Advisors -Col 200 East Southampton Drive Columbia, MO 65203 CONTACT Lisa M. Franke NAME: PHONE FAX (A/C, No, Ext): (573 ) 875-4800 (A/C, Ne):(573) 875-4514 ADDRESS: Ifranke@tigadvisors.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Cincinnati Insurance CompanV 10677 INSURED INSURER B : Travelers Property Casualty Company of America 25674 INSURER C: Federal Insurance Company 20281 Application Software, Inc. INSURER D : Executive Risk Indemnity 35181 PO Box 6044 Columbia, MO 65205 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 TYPE OF INSURANCE ADDL SUER WVD POLICY NUMBER POLICY EFF MM/DDM'YY POLICY EXP M LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR EBL X EPP0134715 03/09/2016 01/01/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence 500,000 $ X MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- ❑ LOC JECT OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY(CEO, ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NUT48JMED AUTOS ONLY AUTOS ONLY X EBA 0134715 01/01/2018 01/01/2019 ,dent INGLE LIMIT acclS $ 1,000,000 BODILY INJURY Perperson) $ BODILY INJURY Per accident $ PeOrP.ER.dent AMAGE $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE EPP 0134715 03/09/2016 01/01/2019 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DED X RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N WANY PROPRIETOR/PARTNER/EXECUTIVE F FICER/MEMBER EXCLUDED? andatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N /A 6JUB-9981 M73-6-17 10/11/2017 10/11/2018 X IPER STATUTE ERH E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 $ C D Cyber Liability Professional Liab 8225-9819 8224-7584 01/01/2018 01/01/2018 01/01/2019 01/01/2019 Occurrence/Aggregate Occurence/Aggregate 5,000,000 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Blanket Additional Insured on General Liability when required by written contract, but only to extent provided in policy form GA472. Blanket Additional Insured on Automobile Liability when required by written contract, but only to extent provided in policy form AA4171. City of Fort Collins Purchasing Department 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 rREPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD