HomeMy WebLinkAbout127605 SKUMATZ ECONOMIC RESEARCH ASSOCIATES - INSURANCE CERTIFICATE®
A4 OP CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDDIYYYY)
02-28-2012
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 ADDITIONALINSURED, 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 statementon this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s). '
PRODUCER
AC
NAME:
TAGGART & ASSOCIATES, INC/PHS
PHONE Es11: [ANC, N.
342321 P: O - F: O -
P&I
PO BOX 33015
ADDRESSPHODUGEH
SAN ANTONIO TX 78265 (
CUSTOMER ID r:
uG`
INSURERISI AFFORDING COVERAGE
NAIC R
INSURED
INSL'RERA: Hartford Casualty Ins CO
SKUMATZ ECONOMIC RESEARCH ASSOCIATES,
INSURER Twin City Fire Ins Co
INC.
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 7N.SURED 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.
MSR
LTR
rypE OF INSURANCEADOL
INSRI
SUCK;
WVDI
POLICY NUMBER
IMMIDDIYYYY)
IMMIDDIYVVY) LIMITS
A
GENERAL LIABILITY
GENERAL LIABILITY
CLAIMS -MADE I X I OCCUR
X General Liab
X
I34 SBA PA5100
03/12/2012
EACH OCCURRENCE
JAMACOMMERCIAL
PREMISES (Ea otturrence)
VIED EXP (Any one person)
03/12/2013 PERSONAL N ADV INJURY
GENERAL AGGREGATE
I PRODUCTS - COMNOP AGG
s 2, 000,000
s 300, 000
$ 10, 000
s 2,000, 060
s 4,000, 000
GENT AGGREGATE LIMIT APPLIES PER:
POLICY °ECT I X I LOC
s 4,000, 000
I $
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
AUTOS
HIRED AUTOS
NON OWNED AUTOS
34 SBA PA5100
I
03/12/2012
03/12/2013
COMBINED SINGLE LIMIT
IEe accident?
$ 2,000,000
11
LI
BODILY INJURY (Per person?
S
BODILY INJURY (Per accidentll
$
PROPERTY DAMAGE
Iper accident?
$
HXSCHEDULED
$
IS
UMBRELLA LIAR I OCCUR
EXCESS LIAB ( CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
I RETENTION $
r
s
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR,PARTNER�EXECUTIVE v I N
OFFICETMEMBER EXCLUDED? u
(Mnndarory In NH)
If yes, describe under
DESCRIPTION OE OPERATIONS below
NIA
34 WEC GM5199
I
03/12/2012
03/12/2013I
x CIISLAATS I I°ER
I
I E.L. EACH ACCIDENT
$ 1, 000, 000
EL DISEASEEAEMPLOYEE
$ 1,000,000
E.L. DISEASE POLICY LIMIT
I s 1, 000, 000
I
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IAllnch ACORD 101. Addilwnal 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.
AUTHORIZED PPRE�TIVE
TIFIN All rinhiR msarved
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD