HomeMy WebLinkAbout127605 SERA INC (SKUMATZ ECONOMIC RESEARCH) - INSURANCE CERTIFICATEAC�RDM CERTIFICATE OF LIABILITY INSURANCE
DATE 09/23/23/200S005ID�
PRODUCER (303)442-1484 FAX (303)442-8822
Taggart & Associates, Inc.
1600 Canyon Boulevard
P. 0. Box 147
Boulder, CO 80306
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC #
INSURED SKUMATZ ECONOMIC RESEARCH ASSOC., CORP.
762 ELDORADO DRIVE, STE 100
SUPERIOR, CO 80027
INSURERA: Hartford Casualty Insurance Co
29424
INSURERB: Twin City Fire Ins Co
29459
INSURER C:
INSURER D:
INSURER E:
:OVER
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
D
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE fMNUDDfYY1
03/12/200S
POLICY EXPIRATION
DATE IMMIDDIM
LIMITS
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
34SBAPASIOO
03/12/2006
EACH OCCURRENCE
$ 2,000 00
DAMAGE TO RENTEDWr
$ 300,00
A
CLAIMS MADE rX OCCUR
MED EXP (Any one person)
$ 10,00(
PERSONAL & ADV INJURY
$ 2,000,00(
GENERAL AGGREGATE
$ 4,000,00
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO-
JECT LOC
PRODUCTS - COMP/OP AGG
$ 4,000,00(
AUTOMOBILE
LIABILITY
ANY AUTO
34SBAPA5100
03/12/200S
03/12/2006
COMBINED SINGLE LIMIT
(Ea accident)
$ 2,000,000
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULEDAUTOS
HIREDAUTOS
NON -OWNED AUTOS
X
BODILY INJURY
IPer accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
OTHER THAN EA ACC
$
AUTO ONLY: AGG
$
EXCESSAIMBRELLA LIABILITY
OCCUR CLAIMS MADE
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION $
$
WORKERS COMPENSATION AND
34WECGMS199
03/12/2005
03/12/2006
X I WC STATU- OTH-
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
$ 100,00(
B
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDED?
H yes describe under
SPECIAL PROVISIONS below
E.L. DISEASE - EA EMPLOYEE
$ 100,00(
E.L. DISEASE - POLICY LIMIT
$ 500,00
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
t is agreed that the Certificate Holder named below is included as an Additional Insured for
eneral Liability.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WALL ENDEAVOR TO MAIL
City of Fort Collins 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Attn : James B . O'Neill - Purchasing BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
P.O. BOX 580 OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
p
Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE
Joan McDonald JPM
ACORD 25120011081 FAX: (970)221-6707 ,.
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
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