HomeMy WebLinkAboutCIGNA CORPORATION - INSURANCE CERTIFICATE (6)AcoR CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
04124/2017
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 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 CONTACT
Marsh USA Inc. NAME:
PHONE FAX
1717 Arch Street (A/C. No. Ext): A/C Not:
Philadelphia, PA 19103-2797 ADDRESS:
Attn: Healthcare.AccountsCSS@marsh.com FAX: 212-948-1307
100607-PRIM-CRIME-17-18
INSURED
CIGNA HEALTH AND LIFE INSURANCE
COMPANY
900 COTTAGE GROVE ROAD
BLOOMFIELD, CT 06152
COVERAGES
CERTIFICATE NUMBER
INSURER A: National Union Fire Insurance Co. of Pittsburgh, PA
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
CLE-004799751-09 RFVISION N1IMBFR-1
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
SUBR
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MM/DD/YYYY
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$
DAMAGE( RENTED
_
OCCUR CLAIMS -MADE El
PREMISESSEa occurrence)
$
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$
HPOLICY PRO ❑ LOC
JECT
PRODUCTS - COMP/OP AGG
$
$
OTHER.
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY (Per person)
$
ANY AU TO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
NON -OWNED
HIRED AUTOS AUTOS
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
J
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DED RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
PER OTH-
STATUTE ER
-
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$
OFRCER/MEMBEREXCLUDED7 ❑
N/A
(Mandatory in NH)
E L. DISEASE - EA EMPLOYEE
$
If yes, describe under
-
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$
A
CRIME / FIDELITY
01-357-02-34
04/30/2017
14130/1011
LIMIT $5,000,000
DEDUCTIBLE $2,500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EVIDENCE OF COVERAGE
GtK I WIGA I L HULULK GANGtLLA I IUN
CITY OF FORT COLLINS
215 NORTH MASON STREET
FORT COLLINS, CO 80524
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
of Marsh USA Inc.
Manashi Mukherjee NA -,A ,-
@ 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD