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HomeMy WebLinkAbout(0182) cert_CLE_CITY OF FORT WORTH_6329022_30.pdf/ AC� "® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 04/30/2021 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 CONTACT NAME:PHONE MARSH USA INC. FAX 1050 CONNECTICUT AVENUE, SUITE 700 A/C No Ext : A/C No), E-MAIL WASHINGTON, DC 20036-5386 Attn: Danaher.oertrequest@Tsarsh.com Fax (212) 948-0503 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: ACE Arroican Insurance 22667 CN102997607-ALL-7/1-20-21 HACH NO INSURED HACHCOIVPANY INSURER B : IndemityIrsCc) OfNorthAl-eflca 43575 INSURER C : ACE Fire UlxlerMters InsuranoE CaTpany 20702 5600 UNDBERC41 DRIVE INSURER D : LOVELAND, CO 80538 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: CLE-006329022-30 REVISION NUMBER: 10 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 INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MM/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY HDOG71448411 07/01/2020 07/01/2021 EACH OCCURRENCE $ 2,000,030 F—v-1 CLAIMS -MADE OCCUR DAMAGE PREM SES� a RENTED ence $ 2,000,000 X MED EXP (Any one person) 10,000 $ Contractual Uabili tY X Broad Form PD PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 POLICY ❑ PRO- JECT ❑ LOC X PRODUCTS - COMP/OP AGG $ 5,000,000 $ OTHER: A AUTOMOBILE LIABILITY ISAF25301183 07/01/2020 07/01/2021 COEaMBIaccidentd.nl)S GLE LIMIT $ 5000000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY L $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ B /� O WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/'4 WLR066928172 (AIDS) V�LR 066928135 (CA,MA,A� SCFC66928214 (W) 07/01/2020 07/01/2020 07/01/2020 07/01/2021 07/01/2021 07/01/2021 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 2 000 000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 2 $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: CONTRACT SS-100376 - 54632 CITY OF FORT WORTH IS ADDITIONAL INSURED FOR GENERAL UABIUTY AND AUTO LIABILITY BUT CINLY AS REQUIRED BY WRITTEN CONTRACT Vv1TH RESPECT TO THE OPEIRATICNS OF THE NAIVED INSURED. CERTIFICATE HOLDER CANCELLATION CITY OF FORT WORTH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1000 THROCl<MORTCN ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN FORT WORTH, TX 76102 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee _rya. ��• = - ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD