The URL can be used to link to this page

Home My WebLink AboutPOUDRE VALLEY HEALTH SYSTEMS - INSURANCE CERTIFICATEACORDM OF LIABILITY INSURANCE CERTIFICATE 0DATE 3126/080mrr) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Flood & Peterson Insurance Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4821 Wheaton Drive HOLDER THIS CERTIFICATE DOES NOT AMEND EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW P O Box 270370 Fort Collins CO 80527 INSURERS AFFORDING COVERAGE NAIC # INSURED Occupational Health Services dba Poudre Valley Health System 1330 Oakndge Dr Fort Collins CO 80525 INSURER Copic Companies INSURER B Safety National Casualty Company 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 NSR TYPE OF INSURANCE POLICY NUMBER PDALTE IMMFDDmEOLICY) EXPIRAT PDATE MM/DDIYYYN LIMITS A GENERAL LIABILITY HCC0008522 04/01/08 04/01/09 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY DAMAGETO RENTED $SOOOOO X I CLAIMS MADE Fx� OCCUR MED EXP Any one person) $5 000 PERSONAL & ADV INJURY $1000000 X Malpractice Liability Included GENERAL AGGREGATE s3,000,000 GEN L AGGREGATE LIMIT APPLIES PER PRODUCTS COMP/OPAGG $1000000 POLICY PRO ECT LOG AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY accident) (Per amident) $ HIRED AUTOS NON OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTOONLV EAACCIDENT $ OTHERTHAN EA ACC $ ANY AUTO $ AUTO ONLY AGG A EXCESS/UMBRELLA LIABILITY UCC0009293 04/01/08 04/01/09 EACH OCCURRENCE $10 000 000 X OCCUR CLAIMS MADE AGGREGATE $1000O 000 $ DEDUCTIBLE $ X RETENTION $ 1 O 000 B WORKERS COMPENSATION AND SPIN19CO 04/01/08 04/01/09 X WCSTATU OTH EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $1 ODD OOO EL DISEASE EA EMPLOYEE $ 1000000 OFFICERWEMBER EXCLUDED' If yes describe under SPECIAL PROVISIONS below Excess Coverage EL DISEASE POLICY LIMIT $1000000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Health Professional Liability Persons Included (if applicable) Professional employees of the named insured other than physicians Professional students of the named insured other than residents Volunteers of the named insured other than physicians and residents City of Fort Collins 256 W Mountain Ave PO Box 580 Ft Collins CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF THE ISSUING INSURER WILL ENDEAVOR TO MAIL 'in DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR ACORD 25 (20011081 1 of 9 BMAVIOGAS nvc n Arnon rn00n0ATInId 4001 IMPORTANT If the certificate holder is an ADDITIONAL INSURED the policy(ies) must be endorsed A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) If SUBROGATION IS WAIVED subject to the terms and conditions of the policy certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s) authorized representative or producer and the certificate holder nor does it affirmatively or negatively amend extend or alter the coverage afforded by the policies listed thereon Awrcu zo s (zouvut$) 2 of 2 #M409945