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HomeMy WebLinkAbout567622 RSM US LLP - INSURANCE CERTIFICATE (4)T ® DATE (MM/DDIYYYY) A`C"R" CERTIFICATE OF LIABILITY INSURANCE 08122/2017 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 endorsement(s). CONTACT PRODUCER NAME: Marsh USA Inc. PHONE FAX 2405 Grand Boulevard,#900 C _ IA/C. Not Kansas City, MO 64108 ADDRESS: _ Attn: KansasCity.CertRequest@marsh.com Fax: 212-948-0015 INSURERISI AFFORDING COVERAGE NAIC # 081817 Eastma INSURED RSM US LLP One South Wacker Drive, Suite 800 Chicago, IL 60606 /�cff Tl CIf�ATC \111\AOC�• INSURER A: Sentry Insurance A Mutual INSURER B : Federal Insurance Compar INSURER C : Liberty Mutual Fire Insuran E: ru1_nnA717R17_n9 RFVlgIC1N NIIMRFR- 9 24988 20281 23035 28460 vTHIS ,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. IN LTR TYPE OF INSURANCE ADDL SUER - - POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY 90-18524-04 11/30/2016 11/30/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR AMA E TURENTED PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMPIOP AGG $ 2,000,000 X POLICY PRO ❑ LOC JECT OTHER. A AUTOMOBILE LIABILITY 90-18524-05 (AOS ) 11130/2016 11/30/2017 COMBINED SINGLE LIMIT Ea accdent $ 1,000,000 .__ BODILY INJURY (Per person) $ A X ANY AUTO 90-18524-06 (MA) 11/30/2016 11/30/2017 BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accdent $ X UMBRELLA LIAB X OCCUR 9364-18-93 11/30/2016 11/30/2017 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE DED V I RETENTION $ $ A WORKERS COMPENSATION 90-18524-01 (ADS) 11/30/2017 X PER OTH- STATUTE ER E.L EACH ACCIDENT $ 1,000,000 - D AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNERlEXECUTIVE OFFICER/MEMBER EXCLUDED? N I (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 90-18524-02 (WI) 11/3012016 11130/2017 E.L DISEASE - EA EMPLOYEE $ 1,000,000 E L DISEASE -POLICY LIMIT 1,000,000 $ C Property YU2-L9L-460316-Ot6 11/30/2016 11/30/2017 Blanket Limit: 1.000,000 Deductible: SEE ATTACHED DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Fort Collins is named as Additional Insured with respect to General and Auto Liability if required to be so by written contract. CERTIFICA tt HULUtK The 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 REPRESENTATIVE of Marsh USA Inc. / Keith A. Stiles [ _ 1 ll-I1000-AU 10 HVIJRU %1%J +l Ivn. Au . U .. .mac .— ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 824056 LOC #: Kansas City ,aco ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY Marsh USA Inc. NAMED INSURED RSM US LLP One South Wacker Drive, Suite 800 Chicago, IL 60606 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Property Deductible: $25,000 For each and every loss or damage to covered property to all location. except $100,000 minimum for Earthquake. Flood in all states except Florida or Wind associated with a named windstorm. Windstorm 5% subject to $250K minimum. Other property deductibles may apply as per policy terms and conditions. ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD