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Home My WebLink AboutAPS HEALTHCARE INC - INSURANCE CERTIFICATEACORD. CERTIFICATE OF LIABILITY INSURANCE DAM(MMUD'YY"') 06/30/10 PRODUCER 1-818-539-2300 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Arthur J. Gallagher E Co. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Insurance Brokers of California, Inc. License #0726293 SOB North Brand Boulevard, Suite 600 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Glandals, CA 91203-3944 Robin Johnzton@ajq.com INSURERS AFFORDING COVERAGE NAIC # INSURED INS Healthcare, Inc. INSURERA: Great Northern Ins Cc 20303 INSURERS: FEDERAL INS CO 20281 APS Healthcare Northwest, Inc. Attn: Debbie Payne 21 Governors Ct. Suits 210 INSURERRWAUSAU BUSINESS INS CO 26069 INSURER D: Windsor Kill, 1® 21244 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. INSR ADO-L POUCYNUMBER POUCYEFFECTIVE POLICY EXPIRATION LIMRS A GENERALLIABILITY 35809570 06/30/10 06/30/11 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE IF —;-]I OCCUR PAMAGrS Eaoo:u D- $1,000,000 MEDEXP(Anyenepereon) $10,000 PERSONALS ADV INJURY $ 1,000,000 GENERALAGGREGATE $2,000,000 GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS -COMP/OPAGG $Included POLICY PRo- F I LOC AUTOMOBILE UABILRY ANVAUTO COMBINED SINGLE LIMIT (Ea aaidant) $ BODILY INJURY (Perparean) $ ALLOWNEDAUTOS SCHEDULED AUTOS BODILY INJURY (Peramiderd) $ HIREDAUTOS NON-OWNEDAUTOS PROPERTY DAMAGE (Peraa,I ant) $ "MOE WIBILRY AUTO ONLY-EAACCIDENT $ OTHERTHAN EAACC $ ANYAUTO $ AUTOONLY: AGG B EXCESSMMBRELLALuaIUTY X I OCCUR CLAIMS MADE 79842253 06/30/10 06/30/11 EACH OCCURRENCE $5,000,000 AGGREGATE $ 5,000,000 E $ DEDUCTIBLE $ RETENTION $ C WORKERSCOMPENSATIONAND WCX—Z91-454866-010 06/30/10 06/30/11 X WCSTATU- I I OTH- EMPLOYERS'WIBILITY ANY PROPRIETOWPARTNER, ECUTIVE E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 OFFICEWMEMBER EXCLUDED'! If yes, de¢dbe uMer SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS The City of Fort Collins is added as Additional Insured for General Liability only as respectsoperations of the Named Insured. Subject to policy terms, conditions, limitations and exclusions. CERTIFICATE HOLDER CANCELLATION*10 day notice 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 $HALL Attn: Purchasing Dept. P O Sox 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Fort Collins, CO 85022 AUTHORREDREPRE$ENTATIVE ^ USA vW`B_r'LW..M ` Arthur J. Gallagher A Co. Insurance Brokers of California, Inc. License #0726293 505 North Brand Boulevard, Suite 600 Glendale, CA 91203-3944 USA The City of Fort Collins Attn: Purchasing Dept. P O Box 580 Fort Collins, CO 85022 USA 36:218:250 IIIIIIII111'IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII This document was brought to you by CertificatesNow and Arthur J. Gallagher A Co. Insurance Brokers of California, Inc. in Glendale, CA. If you have questions regarding the content of this document, please contact the Producer/Agant listed on the certificate of insurance. The data included in this notice and in the attached document is confidential to ConfirmNst and Arthur J. Gallagher A Co. Insurance Brokers of California, Inc. cc: The data included in this notice and in the attached document is confidential to Ebix 6PO and the party responsible for bringing you this information. 1:4 Certificate Delivery by CsrtificatesNow - www.ConfirmNet wrn - 877.669,8600 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 3:4 No Text