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Home My WebLink About15- Dataprose (Lockton Companies) 9-11-15 Certificate of Liability InsuranceLr--))o�HpY'OSe' September 30, 2015 Chris Kukulski City Of Bozeman 121 North Rouse Avenue Bozeman, MT 59771 RE: Certificate of Insurance Dear Chris, Thank you for putting your trust in DataProse and allowing us to handle your billing and printing production needs. Enclosed you will find a current copy of our Certificate of Insurance for our Worker's Compensation and Employer's Liability insurance for your records. We value your relationship and we strive to be the best. If you have any questions or concerns my direct phone number is (972) 462-5410. Sincerely, Curtis Nelson Chief Operating Officer, DataProse, LLC Enclosure 1122 W BETHEL ROAD, COPPELL, TX 750191 800.876.5015 1 WWW.DATAPROSE.COM ACQRIY .- CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) Acct#: 1226830 09/11/2015 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 CONTACT 888-828-8365 Lockton Companies, LLC PHONE FAX 5847 San Felipe, Suite 320A/C No): E MAIL ADDRESS: Houston, TX 77057 INSURERS AFFORDING COVERAGE NAIC # GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑PRO- JECT D LOC OTHER: INSURER A : Indemnity Insurance Co. of North America 43575 PRODUCTS - COMP/OP AGG $ INSURED Insperity, Inc. INSURER B: INSURER C: 19001 Crescent Springs Drive Kingwood, TX 77339 'SEE BELOW INSURER D: INSURER E: COM Ea aBINED SINGLE LIMIT ccident $ INSURER F: BODILY INJURY (Per accident) $ COVERAGES CERTIFICATE NUMBER! RFVISInN NIIMRFR- 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. ILTR TYPE OF INSURANCE INSO WVD SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE D OCCUR EACH OCCURRENCE $_ DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑PRO- JECT D LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS COM Ea aBINED SINGLE LIMIT ccident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident UMBRELLA LIABOCCUR EXCESS LIAB CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATIONPER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A X 048620140 10/01/2015 10/01/2016 OTH- X STATUTE I ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) DATAPROSE, LLC (3181300) IS INCLUDED AS A NAMED INSURED THROUGH ENDORSEMENT. WAIVER OF SUBROGATION IN FAVOR OF CITY OF BOZEMAN WHEN REQUIRED BY WRITTEN CONTRACT. CERTIFICATE HOLDER CANCELLATION CITY OF BOZEMAN 121 NORTH ROUSE AVENUE BOZEMAN, MT 59771 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 GFYI:bi171[leCKel7�Ieii7:71iI:7�iL�7 \li'iL:lIm ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number Insperity, Inc. DATAPROSE, LLC 19001 Crescent Springs Drive, Kingwood, TX 77339 Policy Number Symbol: RWC Number: C48620140 Policy Period Effective Date of Endorsement 10/01/2015 TO 10/01/2016 10/01/2015 Issued By (Name of the Insurance Company) Indemnity Insurance Co. of North America Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. This endorsement shall not operate directly or indirectly to benefit anyone not name in the Schedule. Schedule 1. (X) Specific Waiver Name of person or organization: CITY OF BOZEMAN 121 NORTH ROUSE AVENUE BOZEMAN, MT 59771 ( ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: WHEN REQUIRED BY WRITTEN CONTRACT. 3. Premium: The premium charge for this endorsement shall be percent of the premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Advance Premium: �V Authorized Agent WC 42 03 04 A (1/00) Ptd. In U.S.A. Acct#: 1226830