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MII I IMAM
ACORU. CERTIFICATE OF LIABILITY INSURANCE
DATE
06/24/09DIWW) "
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Parker Smith& Feek, Inca
Bellevue (425-709-3600)
2233 112th Avenue NE
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE -POLICIES BELOW.
Bellevue, WA-98004
INSURERS AFFORDING COVERAGE
NAIL-#--- -
INSURED
t : Mllliman Inc '
1'301 Fiftti'Ave., Suite 3800
' Seattlel,`WA 98101-2605 �
INSURER A: Federal InsuranCe'Com an •`
INSURER B. Pacific Indemnity Co ..__.-....... .. ...-?--
--- ____...... .......
INSURER c: Great Northern Insurance Co.
__ .. .. __. -. •._........
INSURER D:
_ .. _.........
I
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.
INSR
LTR
DD'
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MMIDD/YY
POLICY EXPIRATION
DATE MM/DD/YY
LIMITS
A
GENERAL LIABILITY
35825959
06/30/09
06/30/10
EACH OCCURRENCE
$1,000,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 51OCCUR
DAMAGE SO RENTEDPRE M occurrence)
$1,000,000
MED EXP (Any one person)
$1 O 000
PERSONAL & ADV INJURY
$1,000,000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$1,000,000
POLICY PRO-
JECT XI LOC
C
AUTOMOBILE
LIABILITY
ANY AUTO
73525432
06/30/09
06/30/10
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
X
BODILY INJURY
_(Per person) ..-- -. - --
$- - - - --- --
ALL OWNED AUTOS
SCHEDULED AUTOS
-
- . ._
- -
_ .._ _._ ... _ _ .. _ _.
X
...... ..__.. .... .._...
BODILY,INJURY
_ ....__. _.
_.._ ..__ .. ...._,_....
$.........._ .._ __...... ._.
HIREDAUTOS,. ....'.
.." :�
::s
._
I f_.
r .. ___. _.. _
_... _.
"r .
-- -. ..
XNON-OWNEDAUTOS
PROPERTY DAMAGE
(Per accident) ...... - - -
$ ._ .......... .. .-
. -._._... ._... _ ... ............ _.._.
L._. ._ ..... -...'_
.. _........_ ..
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
-AUTO . n .
_.,..; .... .. .:
.. _ ....:::.....
_.. ._ ... EA ACC
OTHER THAN
$
$
AUTO ONLY: AGG
EXCESSIUMBRELLA LIABILITY
EACH OCCURRENCE
$
AGGREGATE
$
OCCUR CLAIMS MADE
$ '
DEDUCTIBLE _
-
-
- -
$
RETENTION $
B
WORKERS COMPENSATION AND
097179457
06/30/09
06/30/10
-
X WC STATU- LIMOTHFIR
--
EMPLOYERS' LIABILITY
Ally 'FROPRIETORiPARINER/EXECUTIVE
-
- --
-E.L. EACH ACCIDENT --$1,000;000
E.L. DISEASE - EA EMPLOYEE
$1,000,000
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$1,000,000
A
OTHER
35825959
06/30/09
06/30/10
$1,000,000 EA. ACCIDENT
EMPLOYERS
WA & OH STOP GAP
$1,000,000 EA. EMPLOYEE
LIABILITY I
I
1
$1,000,000 POLICY LIMIT
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Exhibit of Insurance.
l.tK 1 Ir'It-A 1 t r1l1LUtK
CITY OF FORT COLLINS
Attn: Jim Hume
256 West Mountain Avenue
Fort Collins, CO 80522-0580
GANGtLLA I IUN
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _Q_ 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
REPRESENTATIVES.
D REPRESENTATIVE
L Rsn coA-j
ACORD 25 (2001/08) 1 of 2 #M91994 LDR00 0 ACORD CORPORATION 1988
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.
ACORD 25-S (2001/08) 2 of 2 #M91994