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Home My WebLink About125038 H & H DATA SERVICES INC - INSURANCE CERTIFICATE (2)ACORDM CERTIFICATE OF LIABILITY INSURANCE 65UFYJK8 °12i28 200099' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Moreton E Company ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4600 S. Ulster St., Ste. 380 HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Denver, Co 80237 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 303-385-2100 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA:Pinnacol Assurance Resource One, LLC .- dba Terra Firma INSURER B. 600 Grant Street, Suite 700 INSURERC: Denver, CO 80203 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 CONTRACTOR 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 ADD' POLICY EFFECTIVE POLICY EXPIRATION LTR INSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDDIYY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ PREMISES Ea cccurence $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE ❑OCCUR MED EXP_(Any _one.person) $ .. I'll.." ......... .............. .............. PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: _ PRODUCTS - COMP/OP AGG $ POLICY PROECT LOC J AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS _- - BODILY INJURY (Per accident) - $ - HIREDAUTOS NON -OWNED AUTOS - - - PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGO EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ .AGGREGATE ........... .................. ............... $ ......... OCCUR CLAIMS MADE DEDUCTIBLE S S RETENTION S A WORKERS COMPENSATION AND 4038719 01/01/2010 01/01/2011 X I WCSTATU- OTH- TORY LIMITS ER EMPLOYERS' LIABILITY ANY PROPRIETOR!PARTNER!EXECUTl%'E .,, F L EACH .ACCIDENT S 1,000,000 E. L. DISEASE - EA EMPLOYEE 5 1,000, 000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E. L. DISEASE -POLICY LIMIT $ 1,000, 000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS This certificate shows that H & H Data Services, Inc. is covered under the workers' compensation policy issued to Resource One, LLC dba Terra Firma. CERTIFICATE HOLDER CANCELLATION City of Fort Collins PO Box 530 Fort Collins, CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 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. AUTHORIZED REPRESENTATIVE Page 1 of 2 HGUKU 20 (ZUUI/US) © 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 (2001/08)