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Home My WebLink About413953 HUDSPETH & ASSOCIATES INC - INSURANCE CERTIFICATE (2)OP ID: GO '4CERTIFICATE OF LIABILITY INSURANCE DATE DYYVY) 12116 12/16/11 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 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 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 endorsements . PRODUCER 303-762-1717 Forsberg Engerman Company 3575 S. Sherman St. Englewood, CO 80113 Doug Engerman CONTACT NAME: Diane Davis PHONE 303-762-1717 FAX ac No a,,, ac No : 303-762-1733 ADDRESS: diane@forsberg-engerman.com PRODUCER HUDSP-1 CUSTOMER ID#: INSURERS AFFORDING COVERAGE NAIC # INSURED Hudspeth Sr Associates Inc INSURER A: Chards Specialty Insurance Co Attn: Robert Levitt INSURERS :PinnacolAssurance 4775 S Santa Fe Circle Englewood, CO 80110 INSURERC: Employers Mutual Casualty Co INSURER D INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: RFVlSION NUMRFR- 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 LTR TYPE OF INSURANCE ADDL BUSHPOLICY POLICY NUMBER EFF MM/DDNYYYI POLICY EXP (MMIDDNYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR X PROP3778989 12/17/11 12/17/12 AMA ET RENTED PREMISES RENT occurrence) $ 300,00 MED EXP (Any one person) $ 25,00 X Pollution Liab PROP3778989 12/17/11 12117112 PERSONAL B ADV INJURY $ 1,000,00 X XCU Included GENERAL AGGREGATE S 1,000,00 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 1,000,00 POLICY X PRO LOC Prof Liab S 1,000,00 C AUTOMOBILE LIABILITY ANY AUTO 2E8548613 02104/12 02/04/13 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) S C SCHEDULED AUTOS HIRED AUTOS 2E8548613 02/04112 02/04/13 X PROPERTY DAMAGE (Per accident) $ X $ C NON-OWNEDAUTOS 2E8548613 02O4112 02/04113 8 UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 19,000,00 $ 19,000,00 A EXCESS LIAR CLAIMSMADEAGGREGATE PROU9964023 12117111 12117112 DEDUCTIBLE $ X 1 a RETENTION S 10 1 B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED' (Mandatory in NH) If yes, desmbe under DESCRIPTION OF OPERATIONS below N / A 4064674 OWNERS EXCLUDED 01/01/12 01/01/13 TH WC STATUOR X - X ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE$ 1,000,00 E.L. DISEASE - POLICY LIMIT 1 $ 1,000,00 C Inst Floater 2C8548613 DEDUCTIBLE $500 1 02/04112 02/04/13 Limit 50,00 C Lease/Rented Equip 2C8548613 DEDUCTIBLE $500 1 02 O4112 02/04/13 Limit 345,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Fort Collins is named as an additional insured with respect to general liability coverage. CITFORT City of Fort Collins 215 N Mason St 2nd Floor PO Box 580 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 V �. /S. 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD