HomeMy WebLinkAbout106536 MILLIMAN INC - INSURANCE CERTIFICATEacofzo® CERTIFICATE OF LIABILITY INSURANCE
-
06/26/2011
THIS CERTIFICATE IS 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 -
-OF -DOES
--BELOW.--THIS-CERTIFICATE_ INSURANCE NOT 66NSTITUTE 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 SUBROGATION -IS WAIVED, subject to the
terms andconditions-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 '
CONTACT
NAME: - .vr._-__....__ r..,l,.,..
'-
Parker, Smith.& Feek; Inc. ' .. .. . _... ._.
PHONE , .. FAX
2233112th Avenue NE -
.,
c . 42 -7 - 0 Arc Not, 425-709-7460 -
E-MAIL
Bellevue, WA 98004
ADDRESS:
PRODUCER
INSURERS AFFORDING COVERAGE
NAICk
INSURED Milliman, Inc.
INSURER A: Federal Insurance Company
INSURER B: Great Northern Insurance Co.
1301 Fifth Ave., Suite 3800
wsuRR c: Pacific Indemnity Co.
Seattle, WA 98101
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.
INSR
TR
OF INSURANCE
ADDLSUBRTYPE
INSR
WVD
POLICY NUMBER
POLICY EFF
MMIDD'YWY
POLICY EXP
MMID'YYYY
DD
LIMITS
A..
"-.'X"
,.
_
::
..
GENERAL LIABILITY
-
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE 1x] OCCUR.$
•n ji, :., ..r , ..,
p,
-
r.
_
35825959
.... ..,.. .. ..-
-. .. - _ • .'.
- ,.
6/30/201.1
..
-
... -
_..
6/30/2012
'---"-'PREMISES
,.. :..,.0
_
EACHOCC U RRENCE
$ -
DAMAGE N
Ea accurtence "-
'$ --- - Q "
.pERSONALB ADVINJURY:
::.. ��:;
$Q.Q
..... .'..,, .. ...
'GENERWAGGREGATE..!o.
$ t, ...:, TOOOOOO
.GEN'L AGGREGATE LIMIT APPLIES PER..
" ..- PRO. ..
POLICY X JECT F7 LOC
PRODUCTS - COMPIOP AGG
$
-
... ..... . ....
$ I
B"
AUTOMOBILE
LIABILITY v
.. - -
ANYAUTO , .. ..
ALL OWNED AUTOS
AUTOS
HIRED AUTOS
NON -OWNED AUTOS
-
�.
-
73525432`
-. -
6/30/2011
' -
6/30/2012.
COMBINED SINGLE UM1T='-
(Eaaccident) ..
$: 1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$SCHEDULED
PROPERTY DAMAGE
(Peramdent)
$
$
Is
UMBRELLA LIAR
EXCESS LIAR
OCCUR
CLAIMS -MADE
-
-
EACH OCCURRENCE
$
AGGREGATE.
$
DEDUCTIBLE
RETENTION $
$
$
C
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY YIN
ANY PROPRIETOWPARTNEPo ECUTIVE
OFFICERIMEMBER EXCLUDED?
randatory,In NH)
es, d..1de ueaer
NIA
F
71719457
6/30/2011
6/30/2012
WC STATU- OTH-
X T V
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYE
$ 1,000,000
E L. DISEASE -POLICY LIMIT
$ 100
A
Employers' Liabilityasa25s59
---
_-__-
WA and OH Slop Gap Employers Liabilty
6/30/2011
6/30/2012
Emp:1,0 0,0 0;Disease Disease EA
Emp:1,000,000;Disease Pol Limit:1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Renarks Schedule, it more space is required)
Exhibit of Insurance.
CITY OF FORT COLLINS
Attn: Jim Hume
256 West Mountain Avenue
Fort Collins, CO 80522-0580
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
1988- 2009 ACORD CORPORATION. All rirthts
ACORD 25 (2009/09) The ACORD name and loao are registered marks of ACORD