Loading...
HomeMy WebLinkAbout107737 ISLAND GROVE REGIONAL TREATMENT CENTER - INSURANCE CERTIFICATE (5)A CORD .iY::. ;]�...:.:} Yi :]�.ii�1; i:: " �.M.i ...... ..., t lq ....1Fw.1{...�wi....L.'. ..:.}:t1i/•:=�/Y. :>} t::: IMM/DONYI . is *( Fy .... ...... :... �: :... t.: ::: .........\ 9 2 05 i:;.i:.}:.:Yi}:.:'9..v.:sv;;.:;ic}`iso:.i:.}}}:.is;:}:.:>:.}ii:.}:.iiii:t;,:.:::: }:a::.::.}:.:.::.::.t}::: `.}:,.. �:ci:.i:::.}:... ... J J PRODUCER Ed Fundingsland THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Talbot Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1601 28th Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE Boulder, CO 80301 COMPANY Pinnacol Assurance Company 303-444-4443 . fax303-449-7365 A INSURED Island Grove Regional Treatment Center COMPANY B 1140 M Street Greley CO 80631 COMPANY C COMPANY D ::.. ::.. : TT....4't+�.::i>:::ii:::S:>::i;:::>::::::::t:>`::�:'::::::'.<.o;:::vr,.f5::y:::>::::::i:::::�::>:::::�;:;;i:}:i::`:?:22:is:J::::>.:3%::::Si::i'::::3i;::5:[:r:;;;;::';:<s:::s:::�s:�i::i�'?`:::::2E:i"3:;:Si:::isk::8::::'5;::3:::::::'S::i3:::£:>:it:::s:�:::>:::y::i::�;i::::?:.::t.<:}::%::;::::>:>.{:i;`::�:c:%:::::G:::�:::::'i":::: 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY DATE EFFECTIVE IMM/DDNYI POLICY EXPIRATION DATE IMMIDDNY) LIMITS GENERAL LABILITY GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE ❑ OCCUR PERSONAL & ADV INJURY S EACH OCCURRENCE S OWNER'S & CONTRACTOR'S PROT FIRE DAMAGE (Any one fire) $ MED EXP (Any one person) S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY (Per person) S ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE S GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHER THAN AUTO ONLY ANY AUTO fp _ °'i<<�dl:",�,''1`•;:^� t j EACH ACCIDENT $ AGGREGATE 9 EXCESS LIABILITY EACH OCCURRENCE S AGGREGATE S UMBRELLA FORM g OTHER THAN UMBRELLA FORM A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 4061756 0/01/2005 10J01J2006 X T'CSTAiT- OTH ER --- EL EACH ACCIDENT S 100, 000 THE PROPRIETOR( X INCL PARTNERS/EXECUTIVE EL DISEASE - POLICY LIMIT S SOO, OOO EL DISEASE - EA EMPLOYEE S 100, 000 OFFICERS ARE: EXCL OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS �::.:::..: ,...: .. :...: .::.....: .: .:..:...: .......:::.: ..::: "�.s::.:�i:•.i? i::isaii:to:.ii:�}:.ir'..:�.ii}}`:.ii:c:�:;}t.i:::}::..:.i:.:�_}:�:t.i:.i:.i;ti::.: :i .::.. .. .... ..... .... ... .. .. ... .. ...rvn...... ........ ... .......n.. .... ..... :. ...I..... ... F.... r...... v....................:..................n:::::..:::n,v..�::Y...:...: .i..:.: ...:...: .::..:..... ........::...::;.i:.,.t.ii,.:;.i;.ii:ci'-::.i:.i:"i5:a:,:t.:e:.i:.ii.:;::;.,:.::..i y::.}:o,ii;t•>"::....}:. �/�1t`%�IGk.G����% J.:........... n.v...: \.ii i.:i.:.....v..: :..: i`•.`vv:ti::..tis isLp:^?:inii:i:.::}::}i'..Nlv:iili?,Z+v..: �::::>}:.'<v: ii ii:.:: ii. City of Fort Collins, Colorado, a municipal Corp SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL P. 0. BOX 580 300 LaPorte Ave. 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, S!1-3aye notice for non-payment BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Fort Collins CO 80522 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE JJ: v..,.::. .... ny: �.: ny: `::: v.::::::n� n.� .::: u.: :..w::. :: ' . :::.. .i..:.... .: :j:.. �: n;..:.v:.v.: j(.j�... ... .. .. ::::::..:.:n �: �: iif ::: i.i is::.i:;p:iniiii::tti:.i:tt.}:ii: n. ............v............. ...............:.�:::N•. �{y� .:i'«.J.��llilF:v'.IG(�.�.::F:�L�.N.Yi�'ii........................................T.:::.......:..:... @ds#2830095 ISLAG-1 ACORD- CERTIFICATE OF LIABILITY INSURANCE °�"' 04/12/0 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 I INSURERA: General Ins. Co. of Amerl Island Grove Regional B: 1140 M Street PNURER R C: Greeley, CO 80634 RDR E: CnVERAGES 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 NSR TYPE OF INSURANCE POLICY NUMBER DA EYMMIDDNYEOLICY1 PDATE IMWEXPIRADDIYYIN LIMITS A GENERALLIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE FX—I OCCUR 24CCO019611 04/01/05 04/01/06 EACH OCCURRENCE $1000000 DAMAGE TO RENTED PREMI ES Me $200OOO MED EXP (Any one person) $1 O 0OO PERSONAL & ADV INJURY $1 QOO OLIO GENERAL AGGREGATE $3 OLIO 000 GENT AGGREGATE LIMIT APPLIES PER: POLICY PRCT O- LOC JE PRODUCTS -COMP/OP AGG $3 000 000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNEDAUTOS 01CG5127331 04/01105 04101/06 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ X X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ EXCESSIUMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ $ WORKERS COMPENSATION AND EMPLOYERS' IJABILITY ANY PROPRIETORIPARTNERIEXECUTNE OFFICERIMEMBER EXCLUDED? If yes, describe Under SPECIAL PROVISIONS below WC SL M1U- OTH- E.L. EACH ACCIDENT Is E.L. DISEASE- EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES 1 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 LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL A_ DAYS WRITTEN :E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL >E NO OBLIGATION OR LIABILITY OF ANY KIN° UPON THE INSURER, rM AGENTS OR AUTHORIZED REPRESENT TIVE Ic/000R -r eAk-fso.%�1 2;. Pr.--r..Mue g zkjt. ACORD 25 (2001/08) 1 of 2 #M311955 TES © ACORD CORPORATION 1988