HomeMy WebLinkAbout113033 GENERALCARE HEALTH SERVICES INC - INSURANCE CERTIFICATEOP"ID J3
ACORD.. CERTIFICATE OF LIABILITY INSURANCE P"IDGEN1
DATE (MM/DD/YYYY)
03/13/09
PRODUCER, ,.......:...: ..- _ _
Rich &, Cartmill Ins of CO '
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
of Colorado LLC" - - "�---- -- '" �
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR - - -- "
8213 W: � 20th Street.
Greeley C0 80634
Phone:' 970 356 8030 Fax: 970.=356-8032
ALTER THE COVERAGE AFFORDED;BY-THE,POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC #
--
INSURED +--`-` °• "
—
INSURER A: Hartford Fire -Insurance. Co-;...
19682..-„ _
"Generalcare Health Services,
Inc.
INSURERR Plnnacol Assurance,,. 11
INSURERC:
_
INSURER D
620 S . . Lemay Ave.
Fort Collins CO 80524
--
—
INSURER E -
COVFRAGFS
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 1"0 WHICH l-HIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT 10 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
D
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MM/DD/YY)
POLICY EXPIRATION
DATE (MM/DD/YY)
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
34SBAUI1965
03/22/09
03/22/10-
EACH OCCURRENCE
$ 1 OOO,O )0
DAMAGETO- RENTED----
PREMISES(Eaoccurence)
- --
$300,000
MED EXP (Any one person)
$ 10,000
CLAIMS MADE X❑ OCCUR
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
s2,000,000
POLICY PRO LOC
JECT
A
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
$ 1, 000, 000' ' .
BODILY,INJURY-
(Per person)
ALL OWNED AUTOS
SCHEDULED AUTOS-
HIRED AUTOS' ;.'345BAUI1965
NON,OWNEDAUT,OS
03/22/09
-_
03/22/1Q:,BODILYINJURY
-- `
X
- --
"(Peraccldent)
_ r
- /a - c`
-X.
PROPERTY DAMAGE
(Per accident) .
;-
•,
n •.: ".:.,
-
._ . •.
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY. AGG
$
ANY AUTO
$
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$ 1, QOO , 000
A
X IOCCUR [:]CLAIMSMADE
34SBAUI1965
03/22/09
03/22/10
AGGREGATE
$1,000,000
$
-
DEDUCTIBLE
X RETENTION $ 10 , 000
$
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
1369942
.-_ - -
01/01/09
01/01/10
X• T.OR'! L'N11TS ; ER
E.L. EACH ACCIDENT__
E.L.DISEASE - EA EMPLOYEE
$500000
$500000
If yes, describe under
SPECIAL PROVISIONS below
El DISEASE - POLICY LIMIT
$500000
OTHER
I
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CFRTIFICATF Hnl DFR CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
City of Fort Collins
P.O. Box 580
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Fort Collins CO 80522
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Shawn A Wotowe
ACORD 25 (2001108) 9 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.
ACORD 25 (2001/08)