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HomeMy WebLinkAbout125038 H & H DATA SERVICES (DHR COLORADO) - INSURANCE CERTIFICATEACOR" CERTIFICATE OF LIABILITY INSURANCE DAT2/2212D/11 `�- 1 vzvzot 1 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: IT 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 endorsement(s). PRODUCER Moreton 8 Company 46005. Ulster St, Ste. 380 CONTACT NAME PHONE FA% . 303-385-2100 AICNo, Eg. (AIC. Noj'. , Denver, CO 80237 E-MAIL - ADDRESS: INSURERS) AFFORDING COVERAGE NAIL 0 INSURER A: Plnnaeol Ass urance INSURED DHR Colorado, LLC TING Terra Firma INSURER B ---------- --- --- - - - 600 Grant Street, Suite 700 INSURER C'. Denver, CO 80203 INSURER D INSURER E : INSURER F' COVERAGES CERTIFICATE NUMBER:EB4C2VJO 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 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRR TYPE OF INSURANCE IINSADDR WND POLICY NUMBER MM DDIYYW MMIDO/YVVY LlMlis NSR W D GENERAL LIABILITY EACH OCCURRENCE s TDAMAGSTC COMMERCIAL GENERAL LIABILITY CLAIMSMADEOCCUR PREMISES Ea oreerrunee S MED EXP Bkn,.ru ourself) 5 PERSONAL 8 ADV INJURY GENERAL AGGREGATE 5 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COM11P/OP AGG S POLICY PRO- LOC I S AUTOMOBILE LIABILITY COMBINED $NGLE UMI ANY AUTO BODILY INJURY (Per person) 5 AONMED SCHEDULED AUTOS OS AUTOS BODILY INJURY (Per cadent) S lJON-0IVNED HIRED AUTOS AUTOS PROPERTY DAMAGE Fur accdent 5 5 UMBRELLA LIAB OCCUR EACH OCCURRENCE S AGGREGATE S EXCESS LIAB CLAIMS -MADE DID RETENTION$ S A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECIfTIVE OFFICERIMEMPER EXCLUDED? MIA 4144784 01/012012 01/01/2013 X WCS"IAIU OTH 1 RY LIMITS ER ELEACH ACCIDENT $ T000,000 EL. DISEASE- EA EMPLOYEE S 1.000,000 (Mandate, in MIN) If yes eescrme ender DESCRIPI ION OF OPERATONS below EL. DISEASE - POLICY LIMIT s 1,000,000 S s S S S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACCRO 101, Additional Remarks Schedule, it more space is required) This certificate shows that H 8 H Data Services, Inc. is covered under the workers' compensation policy issued to DHR Colorado, LLC dos Terra Firma. City of Fort Collins 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 J{ / Page 1 of 1 © 1988-2010 ACORD CORPORATION. All rights ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD