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Home My WebLink AboutPOUDRE VALLEY HOSPITAL - INSURANCE CERTIFICATEACORD- CERTIFICATE OF LIABILITY INSURANCE 0DATE 3126/080mvr) PRODUCER Flood & Peterson Insurance Inc 4821 Wheaton Drive P O Box 270370 Fort Collins CO 80527 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 INSURERS AFFORDING COVERAGE NAIC # INSURED Poudre Valley Hospital Poudre Valley Health Care Inc 2315 E Harmony Rd Suite 200 Fort Collins CO 80528 INSURERA Copic Companies INSURER B Safety National Casualty Company INSURER c Federal Insurance Company INSURER D INSURER 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 PDATE (MMIDDmICYEOLI) PDATE MMIEXPIRATION LIMITS A GENERAL LIABILITY HCC0008522 04/01/08 04101109 EACH OCCURRENCE $1 000 000 X-OMMFRCIAL GENERAL LIABILITY DIR AMAGE TO RENTED $SOO OOO X CLAIMS MADE a OCCUR MED EXP (Any one person) $5 000 PERSONAL &ADV INJURY OOO X Malpractice Liability Included GENERAL AGGREGATE OOO GEN L AGGREGATE LIMITAPPLIES PER PRODUCTS COMP/OPAGG 000POLICYJEo LOG F3OOO AUTOMOBILE LIABILITY AUTO COMBINED SINGLE LIMITANY (Ea accident)ALL BODILY INJURYSCHEDULED (Per person) OWNED AUTOS AUTOS e00LV INJURY (Per accident) $ HIRED AUTOS NON OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTOONLV EAACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY AGG A EXCESSIUMBRELLA LIABILITY UCC0009293 04/01/08 04/01/09 EACH OCCURRENCE $10000000 X OCCUR CLAIMS MADE AGGREGATE $10000 000 $ 9DEDUCTIBLE $ X RETENTION $ 10000 B WORKERS COMPENSATION AND SPIN19CO 04/01/08 04/01/09 X WCSTATu OTH EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE E L EACH ACCIDENT $1 OOO OOO EL DISEASE EA EMPLOYEE $1 OOOOOO OFFICER/MEMBER EXCLUDED' If yes describe under SPECIAL PROVISIONS be. EL DISEASE POLICY LIMIT $1000000 C OTHER Directors & 68006562 04/01/08 04/01/09 $11 000 000 Limit Officers Liab DESCRIPTION OF OPERATIONS / LOCATIONS I 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 (See Attached Descriptions) City of Fort Collins 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 (2001/08) 1 of n 0MA0B9A2 nYtC G1:13,17:L,1 ire it7[?: 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 AGUKU LD 5 JZUU'nei{) 2 of 3 #M409942 DESCRIPTIONS (Continued from Page 1) RE Acquatic Therapy in Community Pools Certificate holder is named as additional insured but only as respects liability arising out of work performed by the named insured (Excluding Workers Compensation) Pb IKIIIi►nI:17