HomeMy WebLinkAboutMILLIMAN - INSURANCE CERTIFICATE (2)ruon4if- RG47
UH I RUAAI
ACORDe CERTIFICATE OF LIABILITY
INSURANCE
o��sD"Y"")
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Parker Smith & Feek, Inc.
Bellevue Office
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
2233112th Avenue NE
Bellevue, WA 98004
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
INSURER A Great Northern Insurance Co.
Mllliman, Inc.
1301 Fifth Ave., Suite 3800
Seattle, WA 98101-2605
INSURER B: Pacific Indemnity Co.
INSURER C:
INSURER D:
INSURER E:
COVERAGES
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.
INU
N R
TYPE OF INSURANCE
POLICY NUMBER
PDOLICY E ATE (MWACTIVE
POLICY EEXDrM DATE PIRATIONLTR
LIMITS
A
GENERAL LIABILITY
35825959
06/30/06
06/30/07
EACH OCCURRENCE
$1 000 OOO
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTEDPREMISES Ma re�l
$1 OOO OOO
CLAIMS MADE I—X-1 OCCUR
MED EXP (Any one Parson
$1 O 000
PERSONAL & ADV INJURY
$1 OOO 000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS -COMPIOP AGG
sincl. InA
POUCY PEG- X LOC
A
AUTOMOBILE
LIABILITY
ANY AUTO
73525432
06/30/06
06/30/07
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,DDO
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
BODILY INJURY
(Per accident)
$
HIREDAUTOS
NON-OWNEDAUTOS
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESSIUMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR CLAIMS MADE
AGGREGATE
$
$
DEDUCTIBLE
$
RETENTION $
A
WORKERS COMPENSATION AND
WC STALIMTU I X JOTH
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
35825959
WA & OH STOP GAP
06/30/06
O6/30/07
E.L. EACH ACCIDENT
$1 000 000
E.L. DISEASE - EA EMPLOYEE
$1 000 000
It S, describe SrECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$2 OOO DDO
B
OTHER
$1,000,000 Ea. Accident
WORKERS COMP.
71719457
06/30/06
06/30/07
$1,000,000 Ea. Employee
$1,000 000 Policy Limit
DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Exhibit of Insurance.
CITY OF FORT COLLINS
Attn: Jim Hume
256 West Mountain Avenue
Fort Collins, CO 80522-0580
LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL n DAYS WRITTEN
:E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
AUTHORIZED
ACORD 25 (2001/08) 1 Of 2 #M68195 ICD00 v ACORD CORPORATION 1988