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HomeMy WebLinkAboutAPS HEALTHCARE - INSURANCE CERTIFICATE (3)A -CORE,,,) CERTIFICATE ®F LIABILITY INSUE\ANCE DATE /DDIYYYY) 06/26/09 PRODUCER 1-818-539-2300 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Arthur J. Gallagher s 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 Robin Johnston@ajg.com INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA:Great Northern Ins Co - 20303 APS Healthcare, Inc. APS Healthcare Northwest, Inc. INSURER B: FEDERAL INS CO 20281 Attn: Debbie Payne INSURERC:TWIN CITY FIRE INS CO CO 29459 21 Governors Ct. Suite 210 Windsor Mill, MD 21244 INSURERD: 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 ADDT NSR P OINSURANCEDATE POLICY NUMBER POLICY EFFECTIVE MM/DD/YY POLICY EXPIRATION DATE MM/DD Y LIMITS _ A GENERAL LIABILITY 35809570 06/30/09 06/30/10 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE FxI OCCUR PREMISES RENTED DAMAGE O. ccure $ 1,000,000 MED EXP (Any one person) $ 10 , 000 PERSONAL BADVINJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $Included POLICY PRO - JECT AUTOMOBILE AUTOMOBILE LIABILITY ANYAUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ . GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EAACC $ ANY AUTO $ AUTO ONLY: AGG B EXCESS/UMBRELLA LIABILITY 79842253 06/30/09 06/30/10 EACH OCCURRENCE $ 5,000,000 X I OCCUR CLAIMS MADE AGGREGATE $ 5 , 000 , 000 $ $ DEDUCTIBLE $ RETENTION $ C WORKERS COMPENSATION EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE 72WSZ00501 06/30/09 06/30/lO WC L'M'T O R X TORYTATU ER E.L. EACH ACCIDENT $ 1 ; 000 , 000 E.L. DISEASE - EA EMPLOYEE $ 1 , 000 , 000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1 , 000 , 000 OTHER _t DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I 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. NCR I IrINN I C nvL_LiC1[ LANk LLLA I IVN 'lU aay not3.ce for non-payment of premium. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION The City Of Fort Collins 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 Attn: Purchasing Dept. P O Boxx580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Fort Collins, CO 85022 AUTHORIZED REPRESENTATIVE ^ ��J�� USA /v4/„ ►\d `Wti; _ a AGUKU Zb (ZUU1/US) ronijon ©ACORD CORPORATION 1988 12378469 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 (2001108)