Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
2018/01/01 CVS Health Corporation Certificate of Liability Insurance
Ir1%..H 1 C Vr LIAMILI I T IIV,UKANUt 12119/2017 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 endorsements . PRODUCER CONTACT MARSH USA, INC. NAME: 99 HIGH STREET PHONE FAx BOSTON, MA 02110 ENo . Attn: CVSCaremark.CertRequest@marsh.com Fax:212-948-5338 lass.,INSURE!MS) AFFORDING COVERAGE NAIC 0 S02406-ALL-GAW-18-19 _ INSURER A: Greenwich Insurance Co m an 22322 INSURED CVS HEALTH CORPORATION INSURER B : XL Insurance America Inc 24554 ONE CVS DRIVE, MC 2180 INSURER C : XL Specialty Insurance Company 37885 WOONSOCKET, RI 02895 INSURER D : INSURER E: INSURER F : 4UvMmAurzb L:t_KIIFIUAIIE NUMBER: NYC-009367237-12 REVISION NUMBER: 7 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 NSR TYPE OF INSURANCE L U POLICY NUMBFR MPOLICY I D YYFYY ML p� LIMITS A X X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F -1 OCCUR SIR: $500,000 RGE300122001 01/01/2018 01/01/2019 EACH OCCURRENCE $ 4,500,000 PREMISE $ 1,000,000SlEaoccurrence MED EXP Any one arson $ X LIQUOR LIABILITY INCLUDED PERSONAL & ADV INJURY $ 4,500,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- X POLICY ❑ JECT LOC GENERAL AGGREGATE $ 28,000,000 PRODUCTS - COMP/OP AGG $ INCLUDED $ OTHER: A AUTOMOBILE LIABILITY RAD943782301 01/01/2018 01/01/2019 COMBINED IN LE LIMIT Ea aocedent $ 5,000,000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident ( ) $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY X PROPERTYDAMAGE Per acclden $ $ SELF -INSURED PHY.DMG. UMBRELLA LIAB OCCUR EACH OCCURRENCE $ REXCESS AGGREGATE $ LIAB CLAIMS -MADE DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBEREXCLUDED? N N/A See Page Two for Policy Numbers ON01120118 01/01/2019 X I PER OTH- STATUTE ER EL. EACH ACCIDENT $ 2,000,000 E. L. DISEASE - EA EMPLOYEE $ 2,000,000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E. L. DISEASE -POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Re: CVS Store fl05267-01, Located: 26973 Newport Road, Menifee, CA 92584. City of Menifee is/are named as an Additional Insured (except Workers Compensation) as their interests may appear, as respects the leased premises, but only to the extent required under the lease of the premises or under any other written contract or agreement. nnM [on) vat, r,,.�ww�.n U-11, —' %wANt,r_LLA I ILJN 05267-01 City of Menifee C.Ity Ci@i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn: City Manager THE EXPIRATION ATE THEREOF, 2974 Haun Road APR 0 8 2019 ACCORDANCE WITH THE POLICY PROVISIONS.E WILL BE DELIVERED IN Menifee, CA 92586 .a AUTHORIZED REPRESENTATIVE P,eceived of Marsh USA Inc. Yevgeniya Muyannina gy�r,,�ci /iZtr p na V 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD _ LOC #: Boston AC7Q ® ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NAMED INSURED MARSH USA, INC. CVS HEALTH CORPORATION ONE CVS DRIVE, MC 2180 POLICY NUMBER WOONSOCKET, RI 02895 CARRIER NAIC CODE EFFECTIVE DATE: AUUITiONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance WORKERS COMPENSATION DEDUCTIBLE PROGRAM: POLICY DATES: JAN 1, 2018 TO JAN 1, 2019 (Coverage A) Policy # States Covered Carrier RWD300122101 AOS XL Insurance America RWR300122201 WI, AK XL Specially Insurance Company LIMIT: $2,000,000 DEDUCTIBLE: $2,000,000 EXCESS WORKERS COMPENSATION PROGRAM POLICY DATES: JAN 1, 2018 TO JAN 1, 2019 (Coverage B) Policy # States Covered Carrier RWE943548301 DC, MA, OH, RI XL Specialty Insurance Company RWE943548401 CT, NC, NJ, VA XL Specialty Insurance Company LIMIT: $500,000 Excess Workers Compensation Self -Insured Retentions: DC, MA, OR RI: $500,000 CT, NC, NJ, VA: $1,000,000 COVERAGE A: Workers Compensation: Statutory COVERAGE B: Employers Liability Limits: $500,000/$500,000/$500,000 COMMON POLICY CONDITIONS A. Cancellation 2. We [Carrier] may cancel this policy by mailing or delivery to the first Named Insured written notice of cancellation at least: a. 10 days before the effective date of cancellation if we cancel for non payment of premium 1) General Liability Additional Insured - Where Required Under Contract or Agreement language per endorsement 61712 (12106): SECTION II - WHO IS AN INSURED, is amended to include as an additional insured: Any person or organization to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of your operations or premises owned by or rented to you. However, the insurance provided will not exceed the lesser of. - The coverage anlor limits of this policy, or The coverage and/or limits required by said contract or agreement. 2) General Liability Earlier Notice of Cancellation Provided By Us language per endorsement CG 02 2410 93: Number of Days' Notice 90 At;UKU 7U7 (ZUUS/U1) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACaREP LOC #: Boston ADDITIONAL REMARKS SCHEDULE Page 3 of 3 AGENCY MARSH USA, INC. POLICY NUMBER CARRIER NAIC CODE NAMED INSURED CVS HEALTH CORPORATION ONE CVS DRIVE, MC 2180 WOONSOCKET, RI 02895 EFFECTIVE DATE: W zuus AGURD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 00024_1$. 0775-001-P02483-1 052 -01 City of l�fu enifes Attn: City Manager 2974 Haun Rai, If ee,A 92586