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DATE(MNA]M/YV1T <br />AC R ® CERTIFICATE OF LIABILITY INSURANCE o7r16r2ots <br />IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. <br />THIS CERTIFICATE <br />THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY ATTEND, EXTEND OR ALTER THE COVERAGE <br />CONTRACT BETWEEN <br />POLICIESAFFORDED BY THE <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICAT HE OLDER. <br />THE SSU NG J SUR R(S), AUTHORIZED <br />IMPORTANT: if the certlticate holder is an ADDITIONAL INSURED, the P011ey{iOS) must have ADDITIONAL INSURED provisions or be <br />may require an <br />H SUBROGATION S WAIVED, subject to the terms and conditions of the policy, certain policies <br />endorsed. <br />endorsement. A statement on this certificate does not confer rights to the certlFlcate holder In 0eu of such endorsement(s). <br />PRODUCER <br />NAME That Risk Mann AmeM Sarvleea Inc <br />Trust Risk Management Services, Inc. doing business in CO as Potomac <br />PHONE FAX <br />AIC No. Ext: 877917.9700 ATC No 877.251.5171 <br />Ee1An <br />ADDRESS: thanesam <br />Risk Management Services, Inc. <br />1791 Paysphere Circle <br />IN9tl WP0R0INGC0VERAGE NAIC0 <br />Chicago, IL 60974 <br />INSURER A: ACE American Insurance company 22667 <br />INSURED <br />INSURER e: <br />INSURER C: <br />Kimberly Miller <br />01SURERD: <br />2308 Owens Ave Unit 204 <br />INSURERE: <br />Fort Collins, CO 80528 7157 <br />INSURER F: <br />ve. <br />COVERAGES CrKJwI I=NUMocn: -- ---""-"'--- <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY <br />PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT <br />THE TERMS EXCLUSIONS AND CONDITION OF ED OR MAY SUCH POLICIES. MITERTAIN, THE __F15MECE AFFORDED is SUBJECT <br />TO WHICHAVE BEEN REDUCED BY PAID LAIMS. <br />TO ALL <br />LTR TYPE OF INSURANCE ISR YIYa POUCYNUMBER t9waar"" pNODOttYYY) LIBITS <br />COMMERCIAL GENERAL L"LLRY <br />CLAIMSMADE F1 OCCUR <br />EAI.'HOO(:UNRENCE S <br />DAMAGE TO RENTED $ <br />PREMISES Ea Acamanm <br />_ <br />MED EXP Piny Ann pavan) <br />PERSONALSADVIN.NRY $ <br />GENERAL AGGREGATE ; <br />PRODUCTS-COMP)OP AGG <br />EEN'LAGDREGATE UWT APPLIES PER: <br />CY a�Go-T <br />rgULOC <br />OTHFR <br />COMBINED SINGLE LIMIT a <br />AUTOMOBILE LIABILITY <br />Me amwent <br />8MLYW.NRY(SWPmeAn) a <br />AHYAInD <br />ALL OWNED SCHEDULED <br />BODILY INJURY (Pcraadda a <br />AUTOS AUTOS <br />NOfOWNED <br />HIRED AUTOS AUTOS <br />PROPERTY DAMAGE S <br />eracdd m <br />S <br />OCCUR <br />EACH OCCURRENCE $ <br />AGGREGATE a <br />�,.=: <br />CLAINSMADE <br />DEO RETF.NnONs <br />WORKERS COWENSATION <br />PER 0 $ <br />STATUTE ER <br />ANO EMPLOYERS LIABILITYEH <br />ANY PRCPRIETORPARMWEXECUIUVE aN <br />OPFICERMEMBER IDO.UOED2 <br />InN <br />NIA <br />LEPC ACCIDENT <br />A PLOVE S <br />E.L. DISFASE•EFd/ <br />a <br />EL DISEASE •POUCYLIMIT <br />De PITON OP OPERATIONS ONow <br />A <br />PSycho[Gglst'S Professional <br />Ltabllity <br />RetmaaVe Date: 09714/2009 <br />58622833984 <br />CW1412019 <br />09/14!2020 <br />Each Incident <br />Annual <br />Aggregate <br />$2,000,000 <br />$4.000,000 <br />MiCRIP110N OF OPERATIONSI LOCATIONS I VEHICLES OCORD 101, AddBlwwl Rtme $chcda*may ba.uchad U mom.wcab re9Almdl. <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br />BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE <br />DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTAnVh <br />ACORD 26 (2016103) 91iR6.2U10 ACUH uurcrvl 1 nun. wt I Ienw lAool•A..• <br />The ACORD name and logo are registered marks ofACORD <br />