HomeMy WebLinkAboutMedicine for Business & Industry, LLC - Insurance Certificate ACC?R" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
12/31/2024
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: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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 CONTACT NAME: Donna Matz
PIMS Insurance Services,LLC. (A/°NN.EA)• (602)222-2109 1FnAic Nut (602)200-2460
5201 N 7th Avenue E-MAIL dmatz@pimsinsurance.com
ADDRESS: @P sinsurance.com
INSURERS AFFORDING COVERAGE NAIC#
Phoenix AZ 85013-1924 INSURERA: Fidelity&Guaranty Insurance Company 35386
INSURED INSURER B: Travelers Property Casualty Company of America 25674
Medicine for Business&Industry,LLC INSURER C:
Attn: Rachel Miller INSURER D:
1495 Garden of the Gods Road INSURER E:
Colorado Springs, CO 80907 INSURER F:
COVERAGES CERTIFICATE NUMBER: 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 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.
INSR !ADDL'SUBR
LTR I TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYYMM/DD/YYYY LIMITS POLICY EFF POLICY EXP
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
CLAIMS-MADE !X! OCCUR DAMAGE TO RENTED 1,000,000
PREMISES Ea occurrence $
MED EXP(Any one person) $ 10,000
A Y N BIP4P471763 01/01/202501/0112026 PERSONAL&ADV INJURY $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
X POLICY PRO- LOC
PRODUCTS-COMP/OP AGG $ 4,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
Ea acc id ent
ANY AUTO BODILY INJURY(Per person) $
A OWNED SCHEDULED N N BIP4P471763 01/01/2025 01/01/2026 BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
X HIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY /� AUTOS ONLY Per accident $
$
X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000
B EXCESSLLIAB CLAIMS-MADE CUP4P537965 01/01/2025 01/01/2026 AGGREGATE $ 1,000,000
DED X I RETENTION$ 10,000 GUEBL/Auto $
WORKERS COMPENSATION ' PERT O TH-
AND EMPLOYERS'LIABILITY Y/N ST A UTE 0
ANY PROPRIETOR/PARTNER/EXECUTIVE
ER
OFFICER/MEMBER EXCLUDED? El N/A E.L.EACH ACCIDENT $
(Mandatory in NH)
MPL �—
If yes.describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
i
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required)
Re: DOT Testing On-Call Agreement
City of Fort Collins is included as an Additional Insured as per written contract for General Liability.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS.
Purchasing Division AUTHORIZED REPRESENTATIVE
P.O.Box 580
Fort Collins CO 80522C.�i..�.. .C 'tr.
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