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A' ° °® CERTIFICATE OF LIABILITY INSURANCE
<br />Mloom )
<br />5/66 /201/201 4
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES II��QQT O ITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, R IT €,. 'E TIkIC�k'j� HI
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require P endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such enment s
<br />dors :-
<br />PRODUCER 1`i J'AL
<br />USI Colorado LLC
<br />1515 Wynkoop, Suite 200
<br />Denver CO 80202
<br />NAM EA Kathy Star
<br />PHONE FAX
<br />Ex - 7- AIC No : - -
<br />-MAIL
<br />ADDRESS :k
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />Y
<br />INSURER A:XL Spec alty Insurance Co.
<br />371585
<br />1/14/2014
<br />INSURED INTCON6
<br />INSURER B: Travelers Pr
<br />INSURER C:TRAVELERS IND CO OF CT
<br />25682
<br />Interwest Consulting Group
<br />P.O. Box 18330
<br />Boulder CO 80308 00
<br />INSURER D:Travelers Indemn ty Compaoy
<br />5658
<br />INSURER E
<br />$1,000,000
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 198333568 REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />INSR
<br />Me
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIODIYYVY
<br />POLICY EXP
<br />flMMVDDNYYY1
<br />LIMITS
<br />B
<br />GENERAL LIABILITY
<br />Y
<br />Y
<br />6807444M622
<br />11/14/2013
<br />1/14/2014
<br />EACH OCCURRENCE
<br />$2,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />DAMAGE I ED
<br />t, PREMISES Ea Ea occurrence)
<br />$1,000,000
<br />CLAIMS -MADE OCCUR
<br />MED EXP (Any one person)
<br />$10,000
<br />PERSONAL B ADV INJURY
<br />$2,000,000
<br />GENERAL AGGREGATE
<br />$4,000,000
<br />GEN'L AGGREGATE
<br />LIMIT APPLIES PER
<br />PRODUCTS - COMP /OP AGO
<br />$4,000,000
<br />POLICY
<br />FX7 PRO- LOC
<br />GCT
<br />$
<br />C
<br />LIABILITY
<br />Y
<br />Y
<br />BA746GM429
<br />11/14/2013
<br />1/14/2014
<br />(Ed accident)
<br />1,000000
<br />BODI LY INJURY(Per person)
<br />$
<br />ANY AUTO
<br />POMOBILE
<br />ALL OWNED SCHEDULED
<br />AUT05 AUTOS
<br />BODILY INJURY(Per accident)
<br />$
<br />NON -OWNED
<br />HIRED AUTOS X AUTOS
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />B
<br />X
<br />UMBRELLA UAB
<br />X
<br />OCCUR
<br />Y
<br />Y
<br />CUP4175T615
<br />11/14/2013
<br />1/14/2014
<br />EACH OCCURRENCE
<br />$1,000,000
<br />AGGREGATE
<br />$1,000,000
<br />EXCESSLIAB
<br />CLAIMS -MADE
<br />DED X RETENTION $0
<br />$
<br />D
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />Y
<br />XVMPIU11133IT134
<br />UB1341TO51
<br />11/14/2013
<br />11/14/2013
<br />1/14/2014
<br />1/14/2014
<br />X WCSTATU- OTH-
<br />VL IT
<br />EL EACH ACCIDENT
<br />1 $1,000,000
<br />ANY PROPRIETOR /PARTNER /EXECUTIVE❑
<br />OFFICER/MEMBER EXCLUDED?
<br />NIA
<br />E. L. DISEASE -EA EMPLOYE
<br />$1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />OE SCRIPTION OF OPERATIONS below
<br />E. L. DISEASE - POLICY LIMIT
<br />1 $1,000,000
<br />A
<br />Professional Liability
<br />Claims Made
<br />DPR9710356
<br />11/14/2013
<br />1/14/2014
<br />Per Claim $1,000,000
<br />Annual Aggregate $3,000,000
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) -
<br />As required by written contract or written agreement, the following provisions apply subject to the policy terms, conditions, limitations and
<br />exclusions: The Certificate Holder is included as Additional Insured for your work, acts or omissions which includes completed operations
<br />under General Liability; Designated Insured under Automobile Liability; and Additional Insured under Umbrella / Excess Liability but only with
<br />respect to liability arising out of the Named Insured's work performed on behalf of the certificate holder and owner. This insurance will apply
<br />on a primary and non - contributory basis. A Blanket Waiver of Subrogation applies for General Liability, Automobile Liability, Umbrella /Excess
<br />Liability and Workers Compensation. The Umbrella / Excess Liability polio provides excess coverage over the General Liability, Automobile
<br />Liability and Employers Liability. �z'Sys
<br />u mmi -vuAIt MULLICK UAIN ULILLURIBUIN
<br />0
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />L c -t Jy2t� THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana r" p, t. ' fOf neN ACCORDANCE WITH THE POLICY PROVISIONS.
<br />.�
<br />PO Box 1988 0S k CIM A
<br />Santa Ana CA 92701 �g5 \S'(a� / AUTHORIZED REPRESENTATIVE
<br />© 1988 -2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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