HomeMy WebLinkAboutSURVEYCONNECT - INSURANCE CERTIFICATELte: 6/12/2006 Time: 4:10 PM To: Amy @ 303 9384015
Page: 001
AC-M!, CERTIFICATE OF LIABILITY
INSURANCE
06/1iz 6
PRODUCER (303)442-1484 FAX (303)442-8822
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Taggart & Associates, Inc.
1600 Canyon Boulevard
Y
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. 0. Box 147
Boulder, CO 80306
INSURERS AFFORDING COVERAGE
NAIC #
INSURED SURVEYCONNECT, INC.
wsURERA Travelers/Phoenix Ins. Co.
2960 DIACONAL HWY STE 202
INSURER B
BOULDER, CO 80301
INSURER
INSURER D
INSURER E
CCIVPRAC3PR
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
DD'
7ypE OF INSURANCE
POLICY NUMBER
POUCYEFFECTIVE
DATE (MMIDDIM
POLICY EXPIRATION
DATE (MMI
LIMITS
GENERAL LIABILITY
I6809038W361PHX06
06/01/2006
06/01/2007
EACH OCCURRENCE
$ 1 ODO 00
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
$ 300,00(
CLAIMS MADE l X] OCCUR
MED EXP (Any oneperson)
00
A
PERSONAL & ADV INJURY
-5,
$ 1 000 00
GENERAL AGGREGATE
$ 2,000,00(
GCN'L AGGREGATE LIMIT APPLIES PER.
PRODUCTS - COMP/OP AGG
$ 2, 000, OQ
POLICY JET LOC
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
$
ANY AUTO
(Ea accident)
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS
(Per person)
$
HIRED AUTOS
BODILY INJURY
NON -OWNED AUTOS
(Per accident)
$
PROPERTY DAMAGE
$
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
7
$
AUTO ONLY. AGG
EXCESSAIMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR ❑ CLAIMS MADE
AGGREGATE
$
DEDUCTIBLE
$
$
RETENTION $
WORKERS COMPENSATION AND
WCSTATU- TV OTi-
R
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
$
MlY PROPRIETOR/PARINER/EXECUIIVE
E.L. DISEASE - EA EMPLOYE -
$
OFFICER/MEMBER FXCLl1DED'+
It vas, describe under
SPECIAL PROVISIONS below
E.L. DISEASE- POLICY LIMIT
$
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
PCOTICUP AT= UnI 11C0 rAurcl I ATII
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYs WRrrTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
City of Fort Collins, 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.
Fort Collins, CO 80522
AUTHORIZED REPRESENTATIVE
Joan McDonald JPM
ACORD 25 (2001/08) FAX: (303)938-4015 1 CORPORATION 1988
tte: 6/12/2006 Time: 4:10 PM To: Amy @ 303 9384015
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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.
ACORD 25 (2001/08)