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Home My WebLink AboutPOUDRE VALLEY HOSPITAL - INSURANCE CERTIFICATE (4)Client#- 125R2 nvucA ACOR& CERTIFICATE OF LIABILITY INSURANCE DgTE (MM DOIYYYY) 10/23/08 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 P O Box 270370 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fort Collins, CO 80527 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA: Copic Companies Valley Hospital NSURERB: Safety National Casualty Company PouPoudre Valley Health System INSURERc: Federal Insurance Company 2315 E 315 Harmony Road, Suite 200 INSURER D: Fort Collins, CO 80528-8620 INSURER E: 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. IN R LTR MOM NSRE TYPEOFINSURANCE POLICY NUMBER POUCYEFFECTIVE DATE D POLICY EXPIRATION DATE (MM/DDIYYI LIMITS A GENERAL LIABILITY HCC0008522 04/01/08 04/01/09 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY X CLAIMS MADE � OCCUft DAMAGE TO RENTEDCeel PREMISES fFe $500000 MED EXP (Anyone person) $5 000 X PERSONAL & ADV INJURY $1000000 Malpractice Liability Included GENERAL AGGREGATE $3 000 000 AGGREGATE LIMIT APPLIES PER: POLICY PRoT JECT LOG PRODUCTS - COMP/OP AGG $1 0001) 0 GEN'L AUTOMOBILE LIABILITY ANY AUTO (Ea accitleDISINGLE LIMIT $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) S HIREDAUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Peraccitlenl) S GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANYAUTO S AUTO ONLY: AGG A EXCESSIUMBRELLA LIABILITY X OCCUR CLAIMS MADE UCC0009293 04/01/08 04/01/09 EACH OCCURRENCE $10 000 000 AGGREGATE $10000 000 DEDUCTIBLE X RETENTION $ 1 O 000 S B EMPLOYERS' LIABILITY WORKERS COMPENSATION AND SP2E33CO 04/01/08 O4/01/O9 X WC STATU- OTH- E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETORIPARTNER/EXECUTIVE OFFICEWMEMSER EXCLUDED? SPECALPR Excess Coverage E.L. DISEASE- EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 PROVISIONS SPECIAL PROVISIONS below C OTHER Directors & 68006562 04/01/08 04/01/09 $11,000,000 Limit Officers Liab DESCRIPTION OF OPERATIONS / 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. (See Attached Descriptions) City of Fort Collins 256 W Mountain Ave PO Box 580 Ft Collins, CO 80522 LD ANY OF THE ABOVE DESCRIBED POUCHES BE CANCELLED BEFORE THE EXPIRATION THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 2A DAYS WRITTEN E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO $0 SHALL 'E NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ---^---,�--••_-ir uro SO4zOOUJ/m4USHUs DXS 0 ACORD 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. ---^•- -�� c ors 3FC4z80uJ11V14uuHb8 DESCRIPTIONS (Continued from Page 1) 03/26/2008 Renewal Certificate Mailed 10/23/2008 Mailed to the holder with a copy emailed to the insured. 1 AMS 25.3 (2001/08) 3 of 3 #5428603/M409989