HomeMy WebLinkAbout223028 THE FAMILY CARE CONNECTION INC - INSURANCE CERTIFICATE (3)AC ORD CERTIFICATE OF LIABILITY INSURANCE OP ID DATE(MMIDDIYYYY)
FAMIL-2 01 05 06
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Front Range Insurance Group HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1109 Oak Park Drive Suite 101 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Fort Collins CO 80525
Phone:970-223-1804
INSURED__ _.
The Family Care Connection
Attn: Wendy Tinkler
2521 Bedford Ct.
Fort Collins CO 80526
:UVEKAGE5
INSURERS AFFORDING COVERAGE
INSURER A: Scottsdale Insurance Company
INSURER B: Pinnacol Assurance
INSURER C: -
INSURER D:
_
INSURER E:
NAIC #
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
DATE MAID
DATE MMIDDIYY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1 r OOO r 000
A
X
X�COMMERCIAL GENERAL LIABILITY
CLS1089395 02/14/05
02/14/06
PREMISES (Ea occurenoe)
$100r000
_.1 CLAIMS MADE [X OCCUR
$ 5 r OOO _
MED EXP (Any one person)
PERSONAL & ADV INJURY
_J
$ 1 r 000 r 000
GENERAL AGGREGATE
$ 1 r 000,r 000
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMPIOP AGG
$ 1 r OOO. r 000
POLICY PRO-
JECT LOC
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
ANY AUTO
(Ea accident)
$
--
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS
(Per person)
$
!
HIRED AUTOS
BODILY INJURY
NON -OWNED AUTOS
(Per accident) $
PROPERTY DAMAGE $
--.-
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
-
OTHER THAN EA ACC
$
AUTO ONLY: AGG
$
EXCESSIUMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR 171 CLAIMS MADE
$
AGGREGATE
DEDUCTIBLE
$
RETENTION $
$
WORKERS COMPENSATION AND
X ITORY LIMITS j ER
B
EMPLOYERS' LIABILITY
4086378
11/01/05
11/01/06
__
— _
E.L. EACH ACCIDENT -
---
$100000
ANY PROPRIETORIPARTNEWEXECUTIVE
_
OFFICER/MEMBER EXCLUDED?
i E.L. DISEASE - EA EMPLOYE
$ 100000
tlyes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
$500000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
The City of Fort Collins is listed as additional insured with regards to
general liability.
CITY OF
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
City of Fort Collins
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Purchasing Division
PO Box 580
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
Fort Collins CO 80522
REPRESENTATIVES.
AUTH EPRESENTATNE
G. uJ
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