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DocuSign Envelope ID:07C464C4-FDB6-434A-A01B-558064E4E858
<br /> IHCSINC-01 DMARCHANT
<br /> ACORO DATE(MMIDDIYYYY)
<br /> CERTIFICATE OF LIABILITY INSURANCE F1/18/2022
<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 NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
<br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER License#92472 CONTACT Danielle Marchant
<br /> Beehive Insurance AgencyPHONE X
<br /> 302 West 5400 South#101 A/C,No,Ext):(801)685-6858 aC,No):
<br /> Salt Lake City,UT 84107-8225 E-MAIL ,dmarchant@beehiveinsurance.com
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURERA:The Travelers Indemnity Company 25658
<br /> INSURED INSURER B:Travelers Property Casualty Co of America 25674
<br /> IHC Scott,Inc. INSURER C:Phoenix Insurance Company 25623
<br /> 9200 East Mineral Avenue,Suite 400 INSURER D:Indian Harbor Insurance Company 36940
<br /> Centennial,CO 80112
<br /> INSURER E
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTRA X COMMERCIAL GENERAL LIABILITY MMIDDIYYYYI
<br /> EACH OCCURRENCE $ 2,000,000
<br /> CLAIMS-MADE OCCUR X XC2K-CO-56426443-IND 1/1/2022 1/1/2023 DAMAGE TPREMISESO RfEaENTED 300,000
<br /> X CONTRACTUAL MED EXP(Any one erson 101000
<br /> X XCU PERSONAL&ADV INJURY 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 4,000,000
<br /> POLICY X zReT LOC PRODUCTS-COMP/OP AGG 4,000,000
<br /> OTHER $
<br /> B COMBINED SINGLE LIMIT 2,000,000
<br /> AUTOMOBILE LIABILITY $
<br /> X ANY AUTO X X VTC2JCAP3K990546TIL 1/1/2022 1/1/2023 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $
<br /> AUTOS ONLY AUUTO�ONLYY PROPERTY AMAGE
<br /> Per accident $
<br /> $
<br /> B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000
<br /> EXCESS LIAB CLAIMS-MADE ZUP3K9905582225 1/1/2022 1/1/2023 AGGREGATE $ 10,000,000
<br /> riDED I X I RETENTION$ $
<br /> C WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE YIN UB1 L2683142225H 1/1/2022 1/1/2023 11000,000
<br /> NIA
<br /> X E.L EACH ACCIDENT
<br /> Mandatory in NH)EXCLUDED E L DISEASE-EA EMPLOYEE $
<br /> 1,000,000
<br /> If yes,desonbe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $
<br /> D Professional CE0744631404 1/1/2022 1/112023 $50K Retention 10,000,000
<br /> D Pollution CE0744631404 1/1/2022 1/1/2023 $50K Retention 10,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required)
<br /> Colorado Department of Transportation is Additional Insured for ongoing&completed operations on a Primary/Non-Contributory basis,Waiver of
<br /> Subrogation applies,and 30 Day Notice of Cancellation applies,in accordance with the attached policy forms.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Colorado Department of Transportation THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> p p ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 2829 W.Howard Place
<br /> Denver,CO 80204
<br /> AUTHORIZED REPRESENTATIVE
<br /> Y �
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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