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HomeMy WebLinkAbout107737 ISLAND GROVE REGIONAL TREATMENT CENTER - INSURANCE CERTIFICATE (3)Client#: 13740 .6ift�42 ACORD. CERTIFICATE OF LIABILITY INSURANCE 04/12/05OmYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Flood & Peterson Insurance Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 211 First Street Eaton, CO 80615 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 970 454-3381 INSURERS AFFORDING COVERAGE NAIC # INSURED Island Grove Regional 1140 M Street INSURER A: General Ins. Co. of Amer! INSURER B: INSURER C: Greeley, CO 60634 INSURER D: INSURER E: 5 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NS NSR TYPE OF INSURANCE POLCY NUMBER POLICY EFFECTIVE DATE MMFECTIV POLICY EXPIRATION DATE EXPIRATION LIMITS A GENERAL LIABILITY 24CCO019611 04/01/05 O4/O1/O6 EACHOCCURRENCE §1 QQQ QQQ X COMMERCIAL GENERAL LIABILITY CLAIMS MADE O OCCUR DAMAGE TOE ELATE�cuDPREMIS arice, $200OOO MED EXP (Any one person) $1 O 000 PERSONAL B ADV INJURY $1 OOO O00 GENERAL AGGREGATE s3,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $3 00Q OOO POLICY PRO LOC JECT A AUTOMOBILE LIABILITY ANY AUTO OICG5127331 04/01/05 04/01/06 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ X HIREDAUTOS NON-OWNEDAUTOS X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC E ANY AUTO $ AUTOONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR CLAIMS MADE $ DEDUCTIBLE $ RETENTION $ _ WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS' LIABILITY E.L. EACH ACCIDENT Is ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS City of Fort Collins, CO, A Municipal Corp. is listed as Additional Insured, as their interest may appear. City of Fort Collins, CO, A Municipal Corp. PO Box 580 215 N. Mason Street Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL In DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENT TIVE /600R r �t+�4ds0^J .�Nf✓/ R�/CR r TNC. ^� ^ - -� %��w "Ww I Or c rFM3l19bb TES 0 ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. MI wmu LGYA k4w1/uo) 2 of 2 #M377955 I, Client#: 13740 ISLGR ACORD.M CERTIFICATE OF LIABILITY INSURANCE DATE ) 0412/05D PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Flood & Peterson Insurance Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 211 First Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Eaton, CO 80615 970 454-3381 INSURERS AFFORDING COVERAGE NAIC # INSURED Island Grove Regional 1140 M Street Greeley, CO 80634 INSURERA: General Ins. Co. of Amerl INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR ADDIL NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MWDDIYY POLICY EXPIRATION DATE MMIDD/YY LIMITS A GENERALLIABILITY 24CCO019611 04/01/05 04/01/06 EACH OCCURRENCE $1 000000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE 5-1 OCCUR DAMAGE TO RENTEDPREMISES (Ea occurrence) $200 000 MED EXP (Any one person) $10 000 PERSONAL B ADV INJURY $1 000 0-00 GENERAL AGGREGATE s3000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s3,000,000 POLICY PRO- LOC JECT A AUTOMOBILE LIABILITY ANY AUTO 01CG5127331 04/01/05 04/01/06 COMBINED SINGLE LIMIT (Ea accident) $1,DDD,DDD BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X X HIREDAUTOS NON-OWNEDAUTOS BODILY INJURY (Peraccident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR CLAIMS MADE E $ DEDUCTIBLE RETENTION WORKERS COMPENSATION ANDLIMITSTATU- I OTH- rR EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYE $ OFFICERWMEMBER EXCLUDED? If yes, describe under E.L. DISEASE -POLICY LtM1T $ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS City of Fort Collins, CO, A Municipal Corp. is listed as Additional Insured, as their interest may appear. City of Fort Collins, CO, A Municipal Corp. PO Box 580 215 N. Mason Street Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL -_3p_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENYTIVE FJooat 'r jPAaesf.6o%j ,ri✓t✓/ a aJGJL o ZT JC. AI.UKU ZO tZUU1/Ut5) 1 of 2 #M311955 TES © ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. •+ Wmu luv tcvu Iiuo) Z of Z W311955