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HomeMy WebLinkAboutCIGNA CORPORATION - INSURANCE CERTIFICATE (5)CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/16/2017 I 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 Aon Risk Services Central, Inc. Philadelphia PA Office CONTACT NAME: PHONE (866) 283-7122 FAX (800) 363-0105 (A/C. No. li (A/C. No.): E-MAIL ADDRESS: One Liberty Place 1650 Market street suite 1000 Philadelphia PA 19103 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: ACE American Insurance Company 22667 Cigna Corporation Et Al 900 Cottage Grove Road Bloomfield CT 06002 USA INSURER B: American Guarantee & Liability Ins CO 26247 INSURER C: Indemnity Insurance Co of North America 43575 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570066943453 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. Limits shown are as requested LTR TYPE OF INSURANCE NSD WVD POLICY NUMBER MM/DD/YYYY MM DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY HDOG 1 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X❑ OCCUR DAMAGE RENTED PREMISES Ea occurrence $1,000,000 MED EXP (Any one person) $ 5 , 000 PERSONAL &ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3 , 000 , 000 X POLICY ❑ PRO ❑ LOC JECT PRODUCTS - COMP/OP AGG $1,000,000 OTHER: A AUTOMOBILE LIABILITY ISAH09060479 07/01/2017 07/01/2018 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY ( Per person) AUTO OWNED SCHEDULED BODILY INJURY (Per accident) IPerANY AUTOS ONLY AUTOS HIRED AUTOS NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE accident Medical Payments Lia $ 5 , 000 B X UMBRELLA LIAB X OCCUR AUC967096609 07/01/2017 07/01/2018 EACH OCCURRENCE $24,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $24 , 000 , 000 DED RETENTION C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR / PARTNER /EXECUTIVE WLRC64411792 07/01/2017 07/01/201$ X I PER OTH- STATUTE ER E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) ❑ N I A E.L. DISEASE -EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONG Below F I. niSFASF-PnLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Named Insured includes: Cigna Health and Life Insurance Company, 900 Cottage Grove Road, Bloomfield, CT 06152. The City of Fort Collins, its officers, agents and employees are included as Additional insured in accordance with the policy provisions of the General Laibility and Automobile Liability policies. 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 POLICY PROVISIONS. City of Fort Collins AUTHORIZED REPRESENTATIVE 215 North Mason Street Fort Collins CO 80524 USA `m r� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD