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POUDRE VALLEY HOSPITAL - INSURANCE CERTIFICATE (3)
Client#: 12582 PVHEA ACORD.,., CERTIFICATE OF LIABILITY INSURANCE 1ATE O/23/080vvrY) 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 P O Box 270370 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fort Collins, CO 80527 INSURERS AFFORDING COVERAGE NAIC # INSURED Poudre Valley Hospital Poudre Valley Health System 2315 E Harmony Road, Suite 200 Fort Collins, CO 80528-8620 INSURER A: Copic Companies INSURERS: Safety National Casualty Company INSURER : Federal Insurance Company _ 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. INSR LTR ADD INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDDIYV POLICY EXPIRATION DATE MMIDD/YY LIMITS A GENERAL LIABILITY HCC0008522 04/01/08 04/01/09 EACH OCCURRENCE $1 000000 X COMMERCIAL GENERAL LIABILITY X CLAIMS MADE O OCCUR DAMAGE TO RENTED $SOO OOO MED EXP (Any one person) $5 000 PERSONAL &ADV INJURY $1000000 X Malpractice Liability Included GENERALAGGREGATE s3,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMWOP AGG $1000000 POLICY PRO- JECT LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Peraccident) $ HIRED AUTOS NON OWNED AUTOS PROPERTY DAMAGE (Per Leiden) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGO A EXCESSIUMBRELLA LIABILITY X OCCUR CLAIMS MADE UCC0009293 04/01/08 04/01/09 EACH OCCURRENCE 00000 _ AGGREGATE 0O 000 F�c DEDUCTIBLEX RETENTION $1O 000 B WORKERS COMPENSATION AND SP2E33CO 04/01/08 04/01/09 X WCSTALIMTU- OTH- I ER EMPLOYERS'LIABILITYANV PROPRIEIORIPARTNER/EXECUTIVE EL. EACH ACCIDENT 0,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 OFFICER/MEMBER EXCLUDED? If yes, describe wider Excess Coverage E.L. DISEASE -POLICY LIMIT 1 $1,000,000 SPECIAL PROVISIONS below C OTHER Directors & 68006562 04/01/08 04/01/09 $11,000,000 Limit Officers Liab DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I 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 256 W Mountain Ave PO Box 580 Ft Collins, CO 80522 � ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION IEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL I0_ DAYS WRITTEN TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR —11-r <' �uvol I Of d 9J4Zd bUJ1M4U8y8H DXS © ACURD CORPORATION 1988 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. - << •• L or a iFJ4LOtl US/IVI4UHJ y DESCRIPTIONS (Continued from Page 1) 03126/2008 Renewal Certificate Mailed 10/23/2008 Mailed to the holder with a copy emailed to the insured. AMS 25.3 (2001/08) 3 of 3 #S4286631M409989