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Home My WebLink AboutCHARLESWORTH CONSULTING LLC - INSURANCE CERTIFICATE 2022-2023CERTIFICATE HOLDER © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECT PRO-POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCURCLAIMS-MADE COMMERCIAL GENERAL LIABILITY GENERAL LIABILITY PREMISES (Ea occurrence)$ DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $RETENTIONDED CLAIMS-MADE OCCUR $ AGGREGATE $ EACH OCCURRENCE $ UMBRELLA LIAB EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY)LIMITS WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNED AUTOS AUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ 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 ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) 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). The ACORD name and logo are registered marks of ACORD COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: INSURED PHONE (A/C, No, Ext): PRODUCER ADDRESS: E-MAIL FAX (A/C, No): CONTACT NAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. X A 2,000,000 PO Box 580 PO Box 9207 PO Box 9207 1,000,000 1-800-247-7756 1-800-247-7756 B X 01/03/2023 01/03/2023 USA X 1,000,000 1828 Walnut Street, Suite 700 1828 Walnut Street, Suite 700 TRAVELERS IND CO OF CT TRAVELERS IND CO OF CT PHOENIX INS CO PHOENIX INS CO X 6305J067658 X Des Moines, IA 50306-9207 Des Moines, IA 50306-9207 5,000 06/30/23 01/01/24 1,000,000 Kansas City, IA 64108 Kansas City, IA 64108 BAIN839917 UB3K091590 300,000 Charlesworth Consulting LLC Charlesworth Consulting LLC Holmes Murphy & Associates - WDM Holmes Murphy & Associates - WDM Fort Collins, CO 80522 25682 25682 25623 25623 skolneswdsm 67578456 67578456 06/30/22 A 01/01/23 06/30/23 1,000,000 X Purchasing Division City of Fort Collins 1,000,000 1,000,000 General Liability and Auto Liability policies when required by written contract or agreement. City of Fort Collins, its officers, agents and employees are included as additional insured with respect to the 06/30/22 2,000,000 Insured Named Locations HMA Group Holdings, LLC Loc. No. Street Address City State Zip 1 Principal Park, One Line Drive Des Moines IA 50309 2 8001 Birchwood Court Johnston IA 50131 4 201 First Street SE, Suite 700 Cedar Rapids IA 52401 5 4550 E. 53rd St., Suite 100 Davenport IA 52807 6 13810 FNB Parkway, Suite 300 Omaha NE 68154 7 5120 South Solberg Avenue Sioux Falls SD 57108 8 7047 E. Greenway Parkway, Suite 210 Scottsdale AZ 85254 9 Waterfront Place, 311 S.W. Water Street, Suite 211 Peoria IL 61602 11 231 S. Bemiston, Suite 800 St. Louis MO 63105 12 7600 East Orchard Road, Suite 230-S Greenwood Village CO 80111 13 12712 Park Central, Suite 100 and 300 Dallas TX 75251-1505 14 390 N Alices Rd Waukee IA 50263 15 14151 Wyandotte Street, Unit #130 Kansas City MO 64145 20 1828 Walnut Street, Suite 701 Kansas City MO 64108 21 1828 Walnut Street, Suite 801 Kansas City MO 64108 18 2727 Grand Prairie Parkway Waukee IA 50263 19 3520 SW Brookside Drive Suite B Grimes IA 50111 22 108 Crestview, Suite 200 Bigfork MT 59911 23 225 S 6th St., Ste 1900 & portion of 18th floor Minneapolis MN 55402 24 132 South State St., Room 315 Salt Lake City UT 84111 25 4 Oak St. SE Minneapolis MN 55455 26 1600 Aspen Commons, Ste 990 Middleton WI 53562 28 One Penn Square West, 25th Floor Philadelphia PA 19102 30 500 Locust Street Des Moines IA 50309 31 165 West Central Avenue Murray UT 84107 32 14388 Proton Dr Dallas TX 75244 2022 Working Schedules.xlsx - Ins. Loc. The information on this page is proprietary. Please do not copy or distribute to others. © 2016 HOLMES MURPHY ASSOCIATES 1 As of: 11/8/2022