PO2018-00000479ATTACHMENT C
Named Insured: Active Network, LLC
Phoenix Insurance Company 25623- 001
Travelers Property Casualty Company of Am 25674- 004
Liberty Insurance Corporation 42404- 001
Travelers Indemnity Co. of America 25666- 001
877- 945- 7378 888- 467- 2378
certificates@willis. com
Willis Insurance Services of Georgia, Inc.
c/ o 26 Century Blvd.
P. O. Box 305191
Nashville, TN 37230- 5191
Global Payments Inc.
Three Alliance Center
3550 Lenox Road NE, Suite 3000
Atlanta, GA 30326
X
X
1, 000, 000
1, 000, 000
10, 000
1, 000, 000
2, 000, 000
2, 000, 000
A HNGLSA- 158D7542- 17 6/ 1/ 2017 6/ 1/ 2018
X
X X
Coll Ded:
100X
Comp Ded:
500
1, 000, 000
X
B HOCAP- 158D7566- 17 6/ 1/ 2017 6/ 1/ 2018
X X
X 10, 000
5, 000, 000
5, 000, 000
C TH7- 651- 291357- 017 6/ 1/ 2017 6/ 1/ 2018
B HROUB- 118D8912- 17 6/ 1/ 2017 6/ 1/ 2018 X
1, 000, 000
1, 000, 000
1, 000, 000
ND
HC2HUB- 2333L415- 17 6/ 1/ 2017 6/ 1/ 2018
Active Network, LLC
01/ 09/2018Page 1 of 1
26041174
Evidence of Coverage Only
Coll: 5165292 Tpl: 2198406 Cert: 26041174
DATE ( MM/ DD/ YYYY)
PRODUCER
INSURED
INSR ADDL SUBR POLICY EFF POLICY
EXPTYPEOF INSURANCE POLICY NUMBERLIMITSLTRINSD WVD ( MM/ DD/ YYYY) ( MM/ DD/ YYYY)
COMMERCIAL GENERAL LIABILITY
AUTOMOBILE LIABILITY
UMBRELLA LIAB
EXCESS LIAB
WORKERS COMPENSATION
AND EMPLOYERS’ LIABILITY Y / N
N / A
Mandatory in NH)
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES ( ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
AUTHORIZED REPRESENTATIVE
CONTACT
NAME:
PHONE FAX
A/ C, NO, EXT):( A/ C, NO):
E- MAIL
ADDRESS:
INSURER( S) AFFORDING COVERAGE NAIC #
INSURER A:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
INSURER F:
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES ( Ea occurence)CLAIMS- MADE OCCUR $
MED EXP ( Any one person)$
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $GEN’ L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/ OP AGG $
PRO-
POLICY LOCJECT
OTHER:$
COMBINED SINGLE LIMIT
Ea accident)
ANY AUTO
OWNED
AUTOS ONLY
BODILY INJURY( Per person)$
SCHEDULED
AUTOS
HIRED
AUTOS ONLY
BODILY INJURY( Per accident)$
NON- OWNED
AUTOS ONLY
PROPERTY DAMAGE $(
Per accident)
EACHOCCURRENCEOCCUR
CLAIMS- MADE AGGREGATE
DED $ RETENTION $
PER OTH-
STATUTE ER
E. L. EACH ACCIDENT $ANY PROPRIETOR/ PARTNER/ EXECUTIVE OFFICER/ MEMBER EXCLUDED?
If yes, describe under
DESCRIPTION OF OPERATIONS below
E. L. DISEASE - EA EMPLOYEE $
E. L. DISEASE - POLICY LIMIT $
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.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
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).
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
CERTIFICATE HOLDER CANCELLATION
ACORD 25 ( 2016/ 03)
1988- 2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
CERTIFICATE OF LIABILITY INSURANCE