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HomeMy WebLinkAbout15- Dataprose, Inc (Lockton Companies and Insurica) Certificate of LiabilityACOR" DATE (MMIDD/YYYY) 05/20/2015 �..--- CERTIFICATE OF LIABILITY INSURANCE Aect#:1226830 ADDL INSR 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 XWACr Lockton Companies, LLC 5847 San Felipe, Suite 320 A/C No.EXt): 888-828-8365[A/C, No): Houston, TX 77057 -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC NSURER-A: Indemnity Insurance Company of North America 43575 INSURED NSURER-B: Insperity, Inc. L/C/F USURER -C: DATAPROSE, LLC 19001 Crescent Springs Drive NSURER-D: Kingwood, TX 77339 NSURER-E: NSURER-F: COVERAGES GERTIFICATE NUMBER: 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 TYPE OF INSURANCE ADDL INSR WEIR VVVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS OMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE DAMAGE TO RENTED PREMISES Ea occurrence MED EXP (Any oneperson) PERSONAL & ADV INJURY GENT AGGREGATE LIMIT APPLIES PER: PRO POLICY JECT LOC OTHER: GENERAL AGGREGATE PRODUCTS — COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED MIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY Per Person $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ MBRELLA LIAB CESS LIAB OCCUR CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ A WORKERS COMPENSATION D EMPLOYERS' LIABILITY NY PROPRIETORIPARTNERIEXECUTIVE Y/ N FFICER/MEMBER EXCLUDED? MANDATORY IN NH)F]x I yes, describe under ESCRIPTION OF OPERATIONS below NIA 048211458 10/01/2014 10/01/2015 X PER I STATUTE OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE—EA EMPLOYEE $I 1,000,000 E.L. DISEASE—POLICY LIMIT $ 1,000,000 ---T 1 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. 1, G 1[ 1 11-11,/11 G r7 V LLJ G;F% 11NI4I1GLLr1 I I V IY CITY OF BOZEMAN 121 NORTH ROUSE AVENUE BOZEMAN, MT 59771 ACORD 26 (2014/01) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TIVE ©1988-2014 ACORD CORPORATION, All Rights Reserved. The ACORD name and logo are registered marks of ACORD Alih�CC> a CERTIFICATE OF LIABILITY INSURANCEF5/20/2015 DATE ) 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 INSURICA 2301 West Plano Parkway Suite 108 Plano TX 75075-8428 CONTACT Brett Atwell NAME: PHONE (469) 443-3488 F1A/C- No- FxthRAC No: (469)443-3977 AIL ADDRESS:batwell@INSURICA.com INSURERS AFFORDING COVERAGE NAIC # INSURERA-Valley Forge Ins. Co. 20508 INSURED DataProse,LLC. 1122 W. Bethel Rd. .Suite 100 Coppell TX 75019 INSURERB:American Casualty Co. of 20427 INSURERC:Continental Casualty Company 0443 INSURERD:Continental Insurance Company35289 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER -14-15 Liability 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 TYPE OF INSURANCE ADDL S BR D POLICY NUMBER POLICY EFF M/DDIYYYY POLICY EXP MMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FxI OCCUR X 4031209640 2/1/2014 2/1/2015 DA AGE TO RENTED 300 000 PREMISES Ea occurrence $ � MED EXP (Any one person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,000 X Includes Errors & Omissions GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 I -XI POLICY PRO LOC I $ AUTOMOBILE LIABILITY Ea BINEDaccidenISINGLE LIMIT 1,000,000 X BODILY INJURY (Per person) $ B ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS 092174977 2/1/2014 2/1/2015 BODILY INJURY (Per accident) $ X NON -OWNED HIRED AUTOS X AUTOS PROPERTY DAMAGE Paraxident $ X UMBRELLA UAB i X OCCUR EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 C EXCESS LIAB CLAIMS -MADE DEO I X IRETENTION10,00C $ 4031209833 2/1/2014 2/1/2015 WORKERS COMPENSATION WC STTATULIMI.- OTH- ITORY ER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ D Network Cyber Liability 4031209704 2/1/2014 2/1/2015 Limit 1,000,000 Aggregate 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder is included as an additional insured where required by written contract. Rh a:a I I a Lr/17 L1iii 1•JR13- •S�l.li3� �/lL L•J c City of Bozeman 121 North Rouse Avenue Bozeman, MT 59771 ACORD 25 (2010105) INS17125 rgmmnnsi m 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 Haselden, CPCU, AIM ©1988-2010 ACORD CORPORATION. All rights reserved. Tho ARr1RIl nnmo onri Innn nro roniafar rl marke of Arnpn 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: C48211458 Policy Period Effective Date of Endorsement 10/01/2014 TO 10/01/2015 05/20/2015 Issued By (Name of the Insurance Company) Indemnity Insurance Company 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 &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 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 0% 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: $0 I •l�� � � „ �� Authorized Agent 1 t ) WC 42 03 04 A (1/00) Ptd, in U.S.A. Acct#: 1226830