HomeMy WebLinkAbout127605 SERA INC SKUMATZ ECONOMIC RESEARCH - INSURANCE CERTIFICATEA`� b® CERTIFICATE OF LIABILITY INSURANCE
DATE
01-21/-20111
THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS 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).
PRODUCER
TAGGART & ASSOCIATES, INC/PHS
342321 P:()- F:()-
P 0 BOX 33015
CONTACT
NAME:
PHONE
ACExtl: AC,NoI:
A
ADDRESS:
PRODUCER
SAN ANTONI O TX 78265
CUSTOMER ID #:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURED
SKUMATZ ECONOMIC RESEARCH ASSOCIATES,
INC.
INSURER A : Hartford Casualty Ins CO
INSURER B : Twin City Fire Ins Co
762 ELDORADO DR. STE 100
INSURER C
SUPERIOR CO 80027
INSURER D
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
TYPE OF INSURANCE
INSR
WVD
POLICY NUMBER
(MM/DD/YYYY)
(MM/DD/YYYY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $ 2, 000,000
COMMERCIAL GENERAL LIABILITY
PREMISES (Ea occurrence) S 300,000
A
� v �
CLAIMS -MADE I X I OCCUR
X General Liab
X
34 SBA PA5100
03/12/2011
MED EXP (Any one person) $ 10,000
03/12/2012 PERSONAL & ADV INJURY S 2, 000,000
GENERAL AGGREGATE $ 4,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY L I PRO- U LOC
JECT
PRODUCTS - COMP/OP AGG $ 4,000,000
$
AUTOMOBILE
LIABILITY -
COMBINED SINGLE LIMIT
(Ea accident)
$ 2, 000,000
ANY AUTO
BODILY INJURY (Per person)
$
ALL OWNED AUTOS
BODILY INJURY (Per accident)
$
A
SCHEDULED AUTOS
HIRED AUTOS
34 SBA PA5100
03/12/2011
03/12/2012
X
PROPERTY DAMAGE
(Per accident)
$
NON -OWNED AUTOS
X
$
$
UMBRELLA LIAB U OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB CLAIMS -MADE
DEDUCTIBLE
$
$
RETENTION $
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE-
OFFICER/MEMBER EXCLUDED? u
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
34 WEC GM5199
03/12/2011
03/12/2012
X ORYSTAT LIMITS OT
`
E.L. EACH ACCIDENT
$ 1, 000,000
E.L. DISEASE -EA EMPLOYEE
$ 1, 000,000
E.L. DISEASE - POLICY LIMIT
$ 1 , 000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Those usual to the Insured's Operations.
CERTIFICATE HOLDER CANCELLATION
City of Fort Collins
Attn: James B. O'Neill
PO Box 580
Fort Collins, CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE
DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZE2 R PRESENTATIVE
v 1988-2009 ACORD CORPORATION. All rights reserved..
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD