HomeMy WebLinkAbout107737 ISLAND GROVE REGIONAL TREATMENT CENTER - INSURANCE CERTIFICATE (4)ACORD lrRlt'
PRODUCER Ed Fundingsland
Talbot Insurance Agency, Inc.
1601 28th Street
Boulder, CO 80301
303-444-4443 . fax303-449-7365
INSURED
Island Grove Regional Treatment Center
1140 M Street
Greley CO 80631
DATE IMM/DD/YYI
09/13/2005
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANY Pinnacol Assurance Company
COMPANY
B
COMPANY
C
COMPANY
D
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.
LTN TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
DATE IMM/DD/YY) DATE IMM/DD/YYI
GENERAL LIABILITY GENERAL AGGREGATE $
COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG $
CLAIMS MADE E]OCCUR PERSONAL & ADV INJURY $
OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $
FIRE DAMAGE (Any one fire) $
MED EXP IAnv one oerson) $
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMIT 15
BODILY INJURY $
IPer person)
BODILY INJURY $
(Per accident)
PROPERTY DAMAGE
$
GARAGE
LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
5
OTHER THAN AUTO ONLY.
EACH ACCIDENT
5
AGGREGATE
$
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
EACH OCCURRENCE
$
AGGREGATE
$
S
A
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
THE PROPRIETOR/ X INCL
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL
OTHER
4061756
10/01/2005
10/01/2006
X ORV LIMT OTH-
EL EACH ACCIDENT
$ 100, 000
EL DISEASE -POLICY LIMIT
5 500, OOO
EL DISEASE - EA EMPLOYEE
S 1 O 0 , 00 0
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
City of Fort Collins, Colorado, a municipal Corp
P. O. Box 580
300 LaPorte Ave.
Fort Collins CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
30 yDAYS WRITTEN NOTICE TOp THE-payment
CERTIFICATE HOLDER NAMED TO THE LEFT,
non
BUST FAILURE TO1 ce MAILf SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
fHONIZED REPRESENTATIVE `