HomeMy WebLinkAboutAPS HEALTHCARE - INSURANCE CERTIFICATE (5)AC-0-RD. CERTIFICATE OF LIABILITY INSURANCE
i2/22/08"YYY)
PRODUCER 1-818-539-2300
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Arthur J. Gallagher a Co.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Insurance Brokers of California, Inc. License #0726293
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
505 North Brand Boulevard, Suite 600
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Glendale, CA 91203-3944
INSURERS AFFORDING COVERAGE
NAIC#
IN
INSURED S Healthcare, Inc.
INSURERA:Great Northern Ins Co
20303
INSURERB: FEDERAL INS CO
20281
APB Healthcare Northwest, Inc.
Attn: Debbie Payne
21 Governors Ct. Suite 210
INSURER C:Hartford Fire In Co
19682
INSURER D:
Windsor Mill, NO 21244
INSURER E:
INIRVAR:J`AcI 7
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.
INES
ADD'I.POLICY
POLICY NUMBER
EFFECTIVE
POLEXPIRATION
ICY
LIMITS
A
GENERALLIASILITY
35809570
04/15/08
04/15/09
EACHOCCURRENCE
$1,000,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE IT]OCCUR
MA'ET EN
PREMISES Ea occerence
$ 1,000,000
MED EXP(Any one person)
$10,000
PERSONAL &ADV INJURY
$1,000,000
GENERALAGGREGATE
$ 2,000,000
GEN'L AGGREGATE
LIMITAPPLIES PER:
PRODUCTS-COMP/OPAGG
$Included
POLICY
E PRO. LOC
AUTOMOBILE
LIABILITY
ANYAUTO
COMBINED SINGLE LIMIT
(Ea accitlent)
$
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY$
(Per accident)
t)
HIRED AUTOS
NON -OWNED AUTOS
PROPERTYDAMAGE
(Peraccidenl)
$
GARAGE LIABILITY
AUTO ONLY -EA ACCIDENT
$
OTHER THAN EAACC
$
ANVAUTO
$
AUTO ONLY: AGO
B
EXCESS/UMBRELLA LIABILITY
X OCCUR CLAIMS MADE
79842253
04/15/08
04/15/09
EACH OCCURRENCE
$5,000,000
AGGREGATE
$5,000,000
$
DEDUCTIBLE
$
RETENTION $
C
WORKERS COMPENSATION AND
72WBH06880
04/15/08
04/15/09
X WCSTATU- OTH
TE
EMPLOYERS'LIAB
ANY PROPRIETOAIPARTPARTNEP/E%ECUTIVE
E.L. EACH ACCIDENT
$1,000,000
E.L.DISEASE-EAEMPWYJEE
$1,000,000
OFFICERIMEMBER EXCLUDED?
II yes, tlesCribound r
SPECIAL PROVISIONS below
E.L. DISEASE-POLICYLIMIT
$1,000, 000
OTHER
DESCRIPTION OF OPERATIONS/ LOCATIONS/VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
The City of Fort Collins is added as Additional Insured for General Liability only as respects operations of the Named
Insured. Subject to policy terms, conditions, limitations and exclusions.
The City of Fort Collins
Attn: Purchasing Dept.
P O Box 580
Fort Collins, CO 85022
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* 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
AUTHORIZED REPRESENTATIVE
USA
insgRn T9
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.
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