HomeMy WebLinkAboutMILLIMAN INC - INSURANCE CERTIFICATEtA1i8:TF!II:L•SScl
MILLIMAN
-------- - - --
ACORD,. CERTIFICATE OF LIABILITY
INSURANCE
06/20/08D"""Y)
PRODUCER
Parker Smith & Feek, Inc.
Bellevue Office
2233 112th Avenue NE
Bellevue, WA 98004
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
Milliman Inc.
1301 Fifth Ave., Suite 3800
Seattle, WA 98101.2605
INSURERA: Great Northern Ins. CO.
INSURERS: Great Northern Ins. CO.
INSURER C: Pacific Indemnity Co.
INSURERD:
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.
SR
LTR
4001
NSR
TYPEOFINSU RANGE
POLICY NUMBER
OLICY EFFECTIVE
DATE MMDD
POLICY EXPIRATION
DATE MMDD
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 7XOCCUR
35825959
06/30/08
06/30/09
EACH OCCURRENCE
$1.000 000
DAMAGE TO RENTED
$1,000,000
MED EXP(Any one person)
$10000
PERSONAL &ADV INJURY
$1,000,000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
CT X lOC
POLICY ECT
J
PRODUCTS - COMP/OP AGG
$1000000
B
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
73525432
06/30/08
06/30/09
COMBINED SINGLE LIMIT
(Ea accident)
$1 r000r000
X
BODILY INJURY
(Per person)
$
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHERTHAN EA ACC
AUTO ONLY: AGG
$
$
EXCESSIUMBRELLA LIABILITY
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
EACH OCCURRENCE
$
AGGREGATE
$
$
$
C
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNEWEXECUTIVE
OFFICERIMEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
71719457
06/30/08
06/30/09
X WC STATU- OTH-
YLIML ES_
E.L. EACH ACCIDENT
._.._
$1,000,000
E.L. DISEASE - EA EMPLOYEE
$1 000.000
E.L. DISEASE POLICY LIMIT
$1,009,000
A
OTHER
Employers Liab.
35825959
WA & OH STOP GAP
06/30/08
06/30/09
$1,000,000 Ea. Accident
$1,000,000 Ea. Employee
$1,000,000 Policy Limit
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Exhibit of Insurance.
CITY OF FORT COLLINS
Attn: Jim Hume
256 West Mountain Avenue
Fort Collins, CO 80522-0580
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _n DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
AUVKU ZO tcuuvua) 7 Ot Z 8Mtf4T8Z n.UUV
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.
AUVKU ZO-D tZUU'I WO) 2 of Z #MB4192