HomeMy WebLinkAbout413953 HUDSPETH & ASSOCIATES INC - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE OP IDGD DATE(MMIDD/YYYY)
HUDSP 1 1 12/17/10
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Forsberg Engerman Company HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
3575 S. Sherman St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Englewood CO 80113
Phone: 303-762-1717 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: American in cislty Lās
INSURER B: Plnnacol Assurance
Hudspeth 6 Associates Inc
Attn: Robert Levitt INSURER C: employers necual Cae acy Co
4775 S Santa Fe Circle INSURER D:
Englewood CO 80110
INSURER E:
I.;UVtKA( hb
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.
INSR
LTR
DD'L
NSRD
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE(MM/DDIYY)
POLICY EXPIRATION
DATE(MWDD/YY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1000000
A
X
X COMMERCIAL GENERAL LIABILITY
PROP3778989
12/17/10
12/17/11
DAMAGETORENTED
PREMISES Eaoccurerce)
$ 300000
MED EXP(Any one person)
E 25000
CLAIMS MADE F OCCUR
PERSONAL BADVINJURY
$ 1000000
X Pollution Llab
PROP3778989
12/17/10
12/17/11
X
XCU Included
GENERAL AGGREGATE
$ 1000000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 1000000
POLICY X JEPRO-
CT LOC
Prof Llab
1000000
AUTOMOBILE
LIABILITY
C
ANY AUTO
2ES548611
02/04/10
02/04/11
COMBINED SINGLE LIMIT
E. accident)
$ 1000000
X
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per person)
$
C
X
HIREDAUTOS
2EB548611
02/04/10
02/04/11
C
NON-OWNEDAUTOS
2E8548611
02/04/10
02/04/11
BODILY INJURY
(Perattment)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
E
ANY AUTO
$
AUTO ONLY:
AGO
EXCESSWMBRELLA LIABILITY
EACH OCCURRENCE
$ 9000000
A
X OCCUR ā CLAIMS MADE
PROU9964023
12/17/10
12/17/11
AGGREGATE
$ 9000000
E
E
DEDUCTIBLE
X RETENTION $ 10000
$
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNEWEXECUTIVE
4064674
01/01/11
01/01/12
WC STATU- OTH-
X TORY LIMITS X ER
E.L. EACH ACCIDENT
s 1000000
E.L. DISEASE - EA EMPLOYEE
$ 1000000
OFFICER/MEMBER EXCLUDED?
OWNERS EXCLUDED
If yes, describe We,
E.L. DISEASE -POLICY LIMIT
$ 1000000
SPECIAL PROVISIONS below
OTHER
C
Inst Floater
2Ca5<aell DeDU-- $See
02/04/10
02/04/11
Limit $50000
C
Lease/Rented Equip
2CO548e11 DE-1ā Bsoa 1
02/04/10 1
02/04/11
Limit $345000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS
City of Fort Collins is named as an additional insured with respect to
general liability coverage.
%,cm I Irn m 1 C 19ULUCK GANGELLATION
City of Fort Collins
215 N Mason St 2nd Floor
PO Box 580
Fort Collins CO 80522-0580
CITFORT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 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.
ACORD 25 (2001/08)
RD CORPORATION 19RR
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.
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