HomeMy WebLinkAboutNORTH RANGE BEHAVIORAL HEALTH - INSURANCE CERTIFICATEACORD N12
06 19/CERTIFICATE OF LIABILITY INSURANCE P ID DP DATE(MM/DDORTH09 09
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Rich & Cartmill Ins of CO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
of Colorado LLC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
8213 W. 20th Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Greeley CO 80634
Phone : 970-356-8030 Fax : 970-356-8032 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: Granite Insurance Company
INSURER B: Plnnacol Assurance "
North Ran e- Behavioral Health INSURERC: National Union Fire Ins Co.
1300 N . 17 th Avenue INSURER D:
Greeley CO 80631 - -
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.
-EXPIRATION
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
DATIE (MM/FDD/YY)E
POLICY
MM DDIYY
LIMITS
A
X
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE � OCCUR
02LX0009055773000
07/01/09
07/01/10
EACH OCCURRENCE
$ 1,000,000
PREMISES (Ea occurence)
$50,000
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
X
Professional Liab
GENERAL AGGREGATE
$ 3,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY PECT RO LOC
J
PRODUCTS - COMP/OP AGG
$ 3,000,000
Em Ben.
1,000,000
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
02LX0009055773000
07/01/09
07�01�10
COMBINED SINGLE LIMIT
(Ea accident)
$ 1 , 000 , 000
X
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)-- . _.... -
$
GARAGE LIABILITY
ANY AUTO _- _.. ...
-
AUTO ONLY - EA ACCIDENT
$ .
OTHER THAN EA ACC
AUTO ONLY: AGG
`$ "
$
C
EXCESS/UMBRELLA LIABILITY
X I OCCUR �CLAIMSMADE
RDEDUCTIBLE
X RETENTION $ 10 , 000
29UD000244418300
07/01/09
07/01/10
EACH OCCURRENCE
s2,000,000
AGGREGATE
$2,000,000
$
$
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED?-
If yes, describe under
SPECIAL PROVISIONS below
4044331
07/01/09
07/01/10
I ER
El. EACH ACCIDENT
$ 100000
E.L. DISEASE - EA EMPLOYEE
$ 100000
E.L. DISEASE -POLICY LIMIT
$ 500000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
City of Fort Collins, Colorado, a Municipal Corporation, is listed as
additional insured as their interest may appear.
rGATILIre TF unl nFR CANCELLATION
City of Fort Collins, Colorado
A Municipal Corporation
300 LaPorte Ave
PO Box 580
Fort Collins CO 80522
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
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Michael J Schmitt CIC
ACORD 25 (2001/08)
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)