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HomeMy WebLinkAbout15- Avolve Software Corporation (Brown and Brown Insurance of AZ, INC) Certificate of LiabiltyACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDlYYYY) 6/9/2015 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(les) 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 CONTNAME:ACT Debbie Lombardero, CIC_ CISR Brown & Brown Insurance of AZ, Inc 2800 North Central Avenue, Suite 1600 Phoenix AZ 85004 PHONE FAX o602-664-7026 `v0 "° EMAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # Y INSURER A -Travelers Prop Cas Co of Amer 25674 /2/2015 INSURED AVOLSOF-01 INSURER B:S and rd Fire Insurance CO 19070 INSURER C:Allied World Assurance Co (US) Inc 19489 Avolve Software Corporation 4835 East Cactus Road Scottsdale AZ 85254 INSURER D: INSURER E INSURER F: MED EXP Anyone person)$10,000 0 COVERAGES CERTIFICATE NUMBER: 609891584 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 LTR 7ypE OF INSURANCE ADDL INSR SUER WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY Y Y ZPP41M23114 /2/2015 /2/2016 EACH OCCURRENCE $1,000,000 COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR qi DAMAGERENTED PREMISESt Ea occurrence $10,000,0.00_ MED EXP Anyone person)$10,000 0 PERSONAL & ADV INJURY $1,000,000 X Dec = $0 GENERAL AGGREGATE $2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY X PRO- JECT LOC $ A AUTOMOBILE LIABILITYY N BA4F626765 /2/2015 /2/2016 COMBINED S G E IMIT Ea accident) $1,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOSX AUTOS A X UMBRELLA LIAB X OCCUR Y Y ZUP71M23120 /2/2015 /2/2016 EACH OCCURRENCE $4,000,000 AGGREGATE $4,000,000 EXCESS LIAB CLAIMS -MADE DED X RETENTION $$10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVEE.L. OFFICER/MEMBER EXCLUDED? N / A Y UB4F631401 /2/2015 /2/2016 X WC STATU- OTH- TORY LIMITS 1 1 Pp EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 C Professional Liability 03093927 /2/2015 /2/2016 Each Claim $3,000,000 Aggregate $3,000,000 Retention $10,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Additional insured applies where required by written contract to General Liability per attached form CG D4 17 07 08 including Waiver of Subrogation, Primary & Non -Contributory applies to General Liability per attached form CG D4 25 07 08. Also, where required per written contract, Additional Insured Automobile Liability applies per attached form CA T3 53 03 10. Excess Liability is Following Form for both General Liability and Automobile Liability. Waiver of Subrogation applies to Workers' Compensation per attached form WC000313 (00)-01. CERTIFICATE HOLDER CANCELLATION ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Bozeman ACCORDANCE WITH THE POLICY PROVISIONS. 121 North Rouse PO Box 1230 Bozeman MT 59771 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD