HomeMy WebLinkAboutMILLIMAN INC - INSURANCE CERTIFICATE (2)riienN!• RAA4
ACORD- CERTIFICATE OF LIABILITY
MILLIMAN
INSURANCE
PRODUCER
Parker Smith & Feek, Inc.
06/25/10D�
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Bellevue (425-709-3600)
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
2233112th Avenue NE
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Bellevue WA 98004
INSURERS AFFORDING COVERAGE
NAIC #
INSURED -
MillimaDlhc: _ _ _ _ _ _
_-.-
INSURER A: Federal Insurance Company
INSURERS Pacific Indemnity Co.
1301 Fifth Ave:; Suite 3800
INSURER c Great Northern Insurance Co.
Seattle, WA, 88101-2605 .
INSURER D: - - - --- .
INSURER E:
rnveewr_cc
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 MAYBE 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.
LTR
INSR[TYPE
OF INSURANCE
POLICY NUMBER
POUCYEFFECTIVE
POUCYEXPIRATION
LIMITS
A
GENERAL
X
LIABILITY35825959
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE O OCCUR
06/30/10
0613/N1
EACH OCCURRENCE
$1000000
DAMAGE TO RENTED
E7 OOO OOO
MED EXP (Anyone person)
$10 000
PERSONAL & ADV INJURY
E1 000 000
GENERAL AGGREGATE
E2 00Q 000
GEN'L AGGREGATE LIMIT APPLIES PER:
JECTPOLICY PRO- X LOC
PRODUCTS-COMP/OP AGG
E1000000
C
AUTOMOBILE
X
LIABILITY
ANY AUTO
73525432
06/30/10
06/30/11
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY(Per perscn)
E
HIRED AUTOS
-
-NON-OWNEOAUrOS .,. ,..
-
----
BODILY INJURY
(Per accident)
-'----
E
PROPERTY DAMAGE
(Per accident) --
E _._..
- _
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
E
ANY AUTO
• C' ".
.OTHER THAN EA ACC
E.
E
AUTO ONLY: AGG
EXCESSNMBRELLA LIABILITY
OCCUR CLAIMS MADE
EACH OCCURRENCE
E
AGGREGATE
E
E
DEDUCTIBLE
E
RETENTION E
E
B WORKERS COMPENSATION AND 71719457 06/30/10 06/30/11
EMPLOYERS' LIABILITY
X WC STATU- OTH-
ANY PRCFR TORIPARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED?
E.L. EACH ACCIDENT E1000000
If yes describe under
SPECIAL PROVISIONS be low
A OTHER 35825959 06/30/10 06/30/11
EMPLOYERS OH, WA & WY
LIABILITY STOP GAP
DESCFUP71ON OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISION9
Exhibit of Insurance.
E.L. DISEASE - EA EMPLOYEE $1,000,000
E.L. DISEASE -POLICY LIMIT $1000000
$1,000,000 Ea. Accident
$1,000,000 Ea. Employee
$7,000,000 Poll Limit
rconerrwrc un, non _
CITY OF FORT COLLINS
Attn: Jim Hume
256 West Mountain Avenue
Fort Collins, CO 80522-0580
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 DD s0 SHALL
IE NO OBLIGATION OR LIABILITY OF ANT KIND UPON THE INSURER ITS AGENTS OR
AUTHORIZED REPRESENTATIVE
25 (2001/08) 1 of 2 #M97898
ICD00 0 ACORD
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 253 (2001108) 2 of 2 OM97898